northern saskatchewan prenatal biomonitoring study ...€¦ · the biomonitoring study was intended...

Ministry of Health, Government of Saskatchewan, 2019

Northern Saskatchewan Prenatal Biomonitoring

Study Technical Summary Report

Northern Saskatchewan Prenatal Biomonitoring Study

Summary Report

Ministry of Health, Government of Saskatchewan, 2019

For more information contact:

Environmental Health Population Health Branch

Miinistry of Health 3475 Albert Street,

Regina, SK, Canada, S4S 6X6

Telephone: 306-787-8847

Website: https://publications.saskatchewan.ca:443/api/v1/products/101374/formats/112048/download

https://publications.saskatchewan.ca/api/v1/products/101374/formats/112048/download

Executive Summary ......................................................................................................................................................... 1

Introduction ..................................................................................................................................................................... 4

Study Rationale ......................................................................................................................................................... 4 Biomonitoring as the Tool of Choice ......................................................................................................................... 5 Stakeholder Analysis ................................................................................................................................................. 6

Alberta’s Biomonitoring Program ......................................................................................................................... 6 Engagement with Northern Communities ............................................................................................................ 6

Glossary ........................................................................................................................................................................... 7

Methodology ................................................................................................................................................................... 9

Scope ......................................................................................................................................................................... 9 Sample Selection ....................................................................................................................................................... 9

Recruitment and Consent ................................................................................................................................... 10

Chemical Selection .................................................................................................................................................. 12 Selection of Biomonitoring Matrix .......................................................................................................................... 13 Laboratory Analysis ................................................................................................................................................. 13 Statistical Analysis ................................................................................................................................................... 14

Analysis and Limitations...................................................................................................................................... 14 Weighting of Concentrations .............................................................................................................................. 14

Ethical Considerations ............................................................................................................................................. 15

Results… ........................................................................................................................................................................ 16

Preamble ................................................................................................................................................................. 16 Pooled Samples ....................................................................................................................................................... 17

Comparisons to Other Studies ................................................................................................................................ 18 Serum Chemical Levels in Northern Saskatchewan ................................................................................................ 18 Results by Chemical Class ........................................................................................................................................ 19

Organic Chemicals ............................................................................................................................................... 19 Cotinine............................................................................................................................................................ 19 Phytoestrogens ................................................................................................................................................ 20 Dioxins and Furans ........................................................................................................................................... 21 Polychlorinated Biphenyls (PCBs) .................................................................................................................... 23 Organochlorine Pesticides ............................................................................................................................... 25 DDT and Related Compounds .......................................................................................................................... 26 Hexachlorobenzene ......................................................................................................................................... 28

Polybrominated Diphenyl Ethers ..................................................................................................................... 30 Perfluorochemicals .......................................................................................................................................... 31 Bisphenol-A ...................................................................................................................................................... 34 Octylphenol ..................................................................................................................................................... 35 Methylmercury ................................................................................................................................................ 36 Phthalates ........................................................................................................................................................ 38 Parabens .......................................................................................................................................................... 39

TABLE OF CONTENTS

Trace Metals and Minerals ................................................................................................................................. 41 Trace Metals (Non-Micronutrients) .................................................................................................................... 41

Aluminum (Al) .................................................................................................................................................. 41 Antimony (Sb) .................................................................................................................................................. 42 Arsenic (As) ...................................................................................................................................................... 43 Barium (Ba) ...................................................................................................................................................... 45 Cadmium (Cd) .................................................................................................................................................. 46 Cesium (Cs) ...................................................................................................................................................... 47 Chromium (Cr) ................................................................................................................................................. 48 Lead (Pb) .......................................................................................................................................................... 49 Mercury (Hg) .................................................................................................................................................... 51 Strontium (SR) .................................................................................................................................................. 53 Uranium (U) ..................................................................................................................................................... 54

Mineral Micronutrients ....................................................................................................................................... 55 Boron (B) .......................................................................................................................................................... 55 Cobalt (Co) ....................................................................................................................................................... 56 Copper (Cu) ...................................................................................................................................................... 57 Iron (Fe) ........................................................................................................................................................... 58 Manganese (Mn).............................................................................................................................................. 59 Magnesium (Mg) .............................................................................................................................................. 59

Molybdenum (Mo) ........................................................................................................................................... 60 Nickel (ni) ......................................................................................................................................................... 61 Selenium (Se) ................................................................................................................................................... 61 Zinc (Zn) ........................................................................................................................................................... 63

STUDY Limitations ......................................................................................................................................................... 64

Biomonitoring ......................................................................................................................................................... 64 Study Design and Implementation .......................................................................................................................... 64

Missing Demographic Information ..................................................................................................................... 64 Pooled Sample Design ......................................................................................................................................... 64 Missing People .................................................................................................................................................... 65 Limited Biological Matrix Selection ..................................................................................................................... 65 Limited Options for Comparison ......................................................................................................................... 65

Discussion ...................................................................................................................................................................... 66

Cross-Jurisdiction Collaboration .............................................................................................................................. 66 Smoking - An Important Source of Exposure and Risk ............................................................................................ 66 Special Consideration in Interpretation .................................................................................................................. 70

Biological ............................................................................................................................................................. 70 Psychological ....................................................................................................................................................... 70

Social ................................................................................................................................................................... 70 Balancing Risk – Breast Feeding is Better ................................................................................................................ 71 Risk Assessments – The Role of Biomonitoring ....................................................................................................... 71

Conclusions .................................................................................................................................................................... 72

Works Cited ................................................................................................................................................................... 73

Acknowledgements ....................................................................................................................................................... 81

studies in the United States .......................................................................................................................... 67

Figure 1: Biomonitoring communities and the resulting pools ..................................................................................... 11

Figure 2: Type of chemicals studied .............................................................................................................................. 13

Figure 3: Infographic of how samples were assigned to geographic pools ................................................................... 17

Figure 4: Concentrations of cotinine in the blood serum of pregnant women in Saskatchewan and Alberta .............. 20

Figure 5: Concentrations of OCDD in blood serum of pregnant women in Saskatchewan and Alberta as determined by lipid weight (A, B) and by total concentration in serum (C and D) ............................................................ 22

Figure 6: Graphical comparison of the concentration of PCBs found in the Saskatchewan study against various large scale biomonitoring initiatives ...................................................................................................................... 24

Figure 7: Concentrations of 4,4’-DDE in blood serum of pregnant women in Saskatchewan and Alberta as determined by lipid weight (A, B) and by total concentration in serum (C and D) ........................................ 27

Figure 8: Concentrations of hexachlorobenzene in blood serum of pregnant women in Saskatchewan and Alberta as determined by lipid weight (A, B) and by total concentration in serum (C and D) ........................................ 29

Figure 9: Contrasting the range of PBDE concentrations in the Saskatchewan study to the range of values for the same in the Alberta study .............................................................................................................................. 31

Figure 10: Concentrations of Perfluorooctanoate (PFOA) in the blood serum of pregnant women in Saskatchewan (A) and Alberta (B) ......................................................................................................................................... 32

Figure 11: Concentrations of Perfluorooctane sulfonate (PFOS) in the blood serum of pregnant women in Saskatchewan (A) and Alberta (B) ................................................................................................................. 33

Figure 12: Concentrations of methylmercury in the blood serum of pregnant women in Saskatchewan (A) and Alberta (B). .................................................................................................................................................... 37

Figure 13: Concentrations of aluminum in the blood serum of pregnant women in Saskatchewan and Alberta ......... 42

Figure 14: Serum concentration of arsenic in pregnant women in Saskatchewan ........................................................ 44

Figure 15: Concentrations of cesium in the blood serum of pregnant women in Saskatchewan and Alberta .............. 48

Figure 16: Concentrations of lead in the blood serum of pregnant women in Saskatchewan (A) and Alberta by geographic region (B) .................................................................................................................................... 51

Figure 17: Concentrations of inorganic mercury in the blood serum of pregnant women in Saskatchewan (A) and Alberta by age (B) .......................................................................................................................................... 52

Figure 18: Concentrations of cobalt in the blood serum of pregnant women in Saskatchewan and Alberta ............... 57

Figure 19: Concentrations of selenium in the blood serum of pregnant women in Saskatchewan and Alberta ........... 63

Figure 20: Tobacco impact on biomonitoring ................................................................................................................ 69

Table 1: Sampling over two years .................................................................................................................................. 11

Table 2: Concentrations of serum octylphenol by pool ................................................................................................ 35

Table 3: Concentration of detected pthalate metabolites by pool ............................................................................... 39

Table 4: Concentrations of paraben isomers by pool .................................................................................................... 40

Table 5: Chemicals found to be statistically significantly different for smokers and non-smokers in biomonitoring

TABLE OF FIGURES

TABLE OF TABLES

1

What was the study about?

Humans are surrounded by chemicals—some are essential to life (e.g., oxygen, iron, selenium), while some may

cause harm under certain circumstances or at certain doses. Environmental chemicals describe those man-made

or naturally occurring chemicals that we are exposed to in our daily lives. People interact with a variety of

chemicals every day. Some may be eaten or drank, breathed in, or absorbed through the skin in consumer

products, water, soil, food, or air.

The biomonitoring study looked at various environmental chemicals found in the blood of pregnant women in

northern Saskatchewan.

What is biomonitoring and what is the purpose of biomonitoring?

Biomonitoring measures chemicals in humans through analyzing blood, urine, hair or breast milk. At this time, it is

the most accurate means we have to determine the amount of a given chemical or element a person is exposed to

in the environment. It gives us a snapshot in time and allows us to know the quantity of a given chemical in the

body, but does not tell us information on the source, duration, or route exposure. The risk to human health is

determined by the complex interplay between the type of chemical, the amount of the chemical, what kind of

exposure, how often the exposure took place and the person exposed.

Information from biomonitoring can:

enable the public and communities to become more aware of and take steps to reduce their exposure to environmental chemicals;

enable comparisons between populations and, over time, assist with government, environment and health agencies to assess risks and take public health or environmental actions; and

assist in the prioritization of further research.

How was the study done?

The study involved the co-operation of pregnant women living in the Northern Administrative District of

Saskatchewan between April 2011 and April 2013. These pregnant women allowed any blood remaining after

their routine prenatal blood tests were completed to be included in the study. Pooling of the residual blood from

855 serum samples was done to ensure there was enough specimen for testing of over 280 environmental

chemicals.

There were six different pools of specimens based on the area of northern Saskatchewan in which the women

resided. This allowed for comparisons across the north as well as comparisons with results from a previously

completed prenatal biomonitoring study in Alberta. Some comparisons were possible with other biomonitoring

studies; however, for some chemicals, only baseline results are available.

EXECUTIVE SUMMARY

2

Who are the agencies involved?

The study was done in partnership between the Saskatchewan Ministry of Health, northern Health Authorities and

Alberta Health.

A Steering Committee was engaged to assist with overall direction of the project. This included representatives

from the Ministries of Health and Environment, northern health authorities, First Nations health authorities, and

the First Nations Inuit Health Branch of Health Canada.

Feedback and support for the project was provided by the Northern Saskatchewan Environmental Quality

Committee, the Boards of the Athabasca Health Authority, the Keewatin Yatthé and the Mamawetan Churchill

River Health Regions, the Northern Intertribal Health Authority Board of Chiefs and Executive Council, the Prince

Albert Grand Council Chiefs and the Meadow Lake Tribal Council Health and Social Services group.

Information was provided to northern health professionals involved in the care of prenatal women, including

public health nurses and physicians. Community awareness was enhanced through the use of radio messaging in

Cree, Dene and English. Pamphlets were available at all health centers and through prenatal education. Posters or

bulletin boards were used at health centers and other community centers.

What environmental chemicals were tested?

The chemicals selected were based on other Canadian biomonitoring projects as well as chemicals that may be of concern in Alberta and Saskatchewan including:

industrial and agricultural by-products,

those used in the manufacture of consumer goods (furniture, building materials, clothing, cosmetics, etc), and

those that naturally exist in the environment.

A variety of mineral micronutrients (required for good health) and trace metals, a wide variety of chemicals

classified as pesticides, PCBs, flame retardants, phlalates, dioxians and furans were tested. Commercial tobacco

contains many chemicals of concern which be can be elevated in people exposed to tobacco smoke, so continine

which is a break-down product of nicotine, was also measured.

What did the study show?

Finding a chemical in the body through testing does not necessarily mean that this poses a health risk or causes a

health problem. Some chemicals (e.g minerals) are required for good health, but too much could increase the

chance of health problems.

Some highlights include:

• Some specific chemicals in the categories such as polybrominated diphenyl ethers (flame retardants),

perfluorochemicals, most pesticides tested, dioxins and furans, were either lower than Alberta levels or

were undetectable. Uranium, nonylphenol and bisphenol A were also not detectable or were below the

level that could be accurately measured.

• Selenium and molybdenum were slightly lower than the average levels in Alberta. Iron levels were also

slightly lower in Saskatchewan than Alberta women but cobalt was higher. Both iron and cobalt help

prevent anemia (weak blood from low iron or vitamin B12).

3

The levels of lead, a heavy metal, were higher than the average levels seen in Alberta. People may be

exposed to lead through lead-based paints (in older homes), drinking water coming in contact with old

lead plumbing, consumer products, or the ingestion of lead shot or lead bullet fragments in country foods.

Smokers or those exposed to second hand smoke tend to have higher levels.

• Mercury levels were comparable to those in Alberta; however, the levels in the far northern area of

Saskatchewan were higher. Methylmercury levels tend to be higher in those who consume a lot of fish

especially large predatory fish.

• Continine levels, a breakdown product of nicotine, were higher in northern Saskatchewan women

indicating higher exposures to tobacco smoke either through smoking or passive smoke exposure.

Exposure to tobacco smoke increases exposure to many other environmental chemicals as well.

OVERALL, MOST OF THE ENVIRONMENTAL CHEMICAL TESTING FOR NORTHERN SASKATCHEWAN REVEALED LEVELS LOWER THAN OR COMPARABLE TO LEVELS IN PREGNANT WOMEN IN THE ALBERTA STUDY.

4

Humans are immersed in chemicals. Some of these chemicals, such as oxygen and hydrogen, are essential to life.

On the other hand, some chemicals may cause harm under certain circumstances. Environmental chemicals are

those chemical substances we are exposed to in our daily lives; some are human-made while others are naturally

occurring; as with all chemicals, they may be helpful, harmful or neither.

This biomonitoring study should be seen as foundational work for developing a better understanding of the people

of Saskatchewan’s exposures to environment chemicals of interest or potential concern. Biomonitoring is a tool

that allows for a population level understanding of what chemicals people are being exposed to and to some

degree, how much.

The biomonitoring study was intended to establish typical human exposures to environmental chemicals during

pregnancy for women living in northern Saskatchewan. This purpose arose from several streams of thought:

INTRODUCTION

STUDY RATIONALE

Saskatchewan has never systematically performed population level biomonitoring. In Canada,

there is information available for overall Canadian biomonitoring results, but Saskatchewan

was not included in the sampling for the Canadian Health Measures Survey until its fourth

cycle in 2014/15. There is also biomonitoring information available for northern Canada (north

of 60) there are biomonitoring projects involving some Canadian First Nations communities,

including some in Saskatchewan. The data collected from a systematic biomonitoring program

could inform governments, researchers and health practitioners in a variety of ways.

The Alberta Ministry of Health is a key partner. They have a similar biomonitoring program.

Periodically they collect information; however, they were also interested in establishing a

comparator similar to their population prior to industrial particularly oil and gas development.

Parts of northern Saskatchewan are relatively untouched by oil and gas developments and so

this population was considered a reasonable comparitor.

New environmental chemicals continue to be developed with the potential for human health

exposure. Biomonitoring has potential to inform further action.

Pregnant women are of particular concern in terms of potentially adverse exposures due to the

sensitive nature of the fetus, and as it is routine for these women to have blood studies done

5

Biomonitoring is the measurement of chemicals or their metabolites (break down products) in humans. It is done

by measuring these chemicals in a biological matrix such as blood, urine, hair or breast milk.1 At this time, it is the

most accurate means we have to determine the amount of a given chemical or element a person is exposed to in

the environment. This information can then be used to inform decisions about health risks.

All persons interact with a variety of chemicals on any given day. Some may be eaten, inhaled or absorbed

through the skin (termed the ‘route’ of exposure) in any or all consumer products, water, soil, food or air. The risk

to human health is determined by the complex interplay between the chemical in question, the dose (amount) of

the chemical, the routea and frequency of exposure, and the person exposed.2

The internal dose is the measurable amount of a chemical that exists in a biological matrix. It depends on both the

pharmacokinetics (what the body does to the chemical) and the pharmacodynamics (what the chemical does to

the body) of a particular chemical in an individual. It is also affected by the same factors that are considered in

human health risk assessments (chemical characteristics, route of exposure, duration of exposure, frequency of

exposure and receptor).

Biomonitoring gives us a snapshot in time. It allows us to determine the internal dose, but only for a specific point

in time. It does not provide us with information on the source, duration or route of exposure, all of which are

fundamental in developing a complete understanding of exposure. Periodic biomonitoring, where biomonitoring

is repeated in a given population at a certain frequency, still cannot account for source, duration or route, but it

does allow for comparison over time.

Even with its limitations, biomonitoring has proven valuable in understanding population exposures to

environmental chemicals. In Canada, in addition to the Alberta program, the Canadian Health Measures Survey10

(CHMS), the Maternal-Infant Research on Environmental Chemicals (MIREC), the First Nations Biomonitoring

Initiative29, and the Northern Contaminants Program (in Nunavut, Northwest Territories and the Yukon) all used

biomonitoring as a tool to identify and monitor population exposures to environmental chemicals.

a Ingestion, inhalation, injection or dermal absorption

BIOMONITORING AS THE TOOL OF CHOICE

The data provided from biomonitoring has the capacity to inform governments, researchers and health

practitioners by152:

Establishing baseline levels of chemicals in the Canadian population.

Allowing for comparison of exposure to environmental chemicals among different populations.

Identification of chemicals for which further action should be taken to protect the public’s health.

Supporting future research on potential links between exposure to certain chemicals and specific health

effects.

Contributing to international monitoring programs.

6

Biomonitoring is a novel tool with great promise, but there are limitations on what can be drawn from the

information collected using this methodology. These limitations will be explored further in the “Limitations”

sections of this document and should be considered seriously in interpreting the findings of this study.

The Alberta Biomonitoring Program began with Phase I in 2005 and focussed on pregnant women.3 The second

phase included a study of Southern Alberta children in 2006.4 Phase III of this program is underway.

Alberta’s program was implemented after the development of the oil sands in Northern Alberta and therefore, a

baseline level of population exposure to chemicals of potential concern was not obtained prior to establishment of

the industry.

Northern Saskatchewan was deemed a suitable population to act as a proxy baseline. Subsequently,

Saskatchewan was offered the opportunity to undergo its own biomonitoring initiative which, along with providing

comparison values for Alberta, can provide some valuable information on Northern Saskatchewan’s exposures.

At the outset, a steering committee for the study was engaged to assist with overall direction of the project.

Representatives included: the Saskatchewan Ministries of Health and Environment, northern health authorities

and northern health regions, First Nations Health Authorities, and the First Nations Inuit Health Branch of Health

Canada.

The goals, principles, design, and purpose were shared with a variety of northern leadership, health and/or

environmental groups who provided feedback and support for the project including Northern Saskatchewan

Environmental Quality Committee, the Boards of the Athabasca Health Authority, the Keewatin Yatthé and the

Mamawetan Churchill River Health Regions, the Northern Intertribal Health Authority Board of Chiefs and

Executive Council, the Prince Albert Grand Council Chiefs and the Meadow Lake Tribal Council Health and Social

Services group.

Further information was provided to northern health professionals involved with the care of prenatal women

including public health nurses and physicians. Community awareness was enhanced through the use of radio

messaging in Cree, Dene and English as well as pamphlets available at all health centers and through prenatal

education, and posters used at health centers and other community centers or bulletin boards

STAKEHOLDER ANALYSIS

ALBERTA’S BIOMONITORING PROGRAM

ENGAGEMENT WITH NORTHERN COMMUNITIES

7

Aliquot A small portion of the total sample.

Arithmetic mean The average set of numbers, calculated by adding them together and dividing by the

number of terms in the set.

Background

concentration of

chemicals

A subjective term normally used to describe the baseline concentration of a chemical in

humans or the environment where there has been no occupational or accidental

exposure to high concentrations.

Bioaccumulation Accumulation of substances in an organism (plant, animal or human) above what is in the

environment (e.g. water, air, food).

Biological matrix Body fluid or tissue (e.g. blood, urine, breast milk, expelled air, hair, nails, etc.)

Biomonitoring The measurement of chemicals in human bodies. These measurements are often made

by analzying blood, urine or other body tissues such as hair or nails.

Blood serum The clear yellowish liquid part of whole blood. It is obtained by clotting the whole blood,

and then by separating the liquid from the solids.

Congener Chemicals that are related to each other by origin, structure, or function.

Descriptive statistics Statistical analysis that describes or summarizes the data in a meaningful way.

Environnmental

chemicals

The chemicals that can be found in the world around humans - both in nature and in the

man-made environment.

Fungicide A chemical that destroys fungus.

Geometric mean A type of mean or average that uses the product of a set of numbers (the nth root of the

product of n numbers).

Internal dose The amount of an agent/compound that enters the body by crossing an exposure surface

that acts like an absorption barrier such as the skin, or gastrointestinal lining. The same

as "absorbed dose".

Isomer Each of two or more compounds with the same chemical formula that have different

arrangements of atoms leading to different properties.

Limit of detection

(LOD)

The lowest concentration at which chemical can be measured.

GLOSSARY

8

Limit of

quantification (LOQ)

The limit of quantitation (LOQ) is set at a higher value than the limit of detection and is

the concentration at which concentrations of an analyte can be reported with

confidence.

Lipid Synonym of fat or oils.

Lipid serum weight This is the concentration of a lipophilic chemical presented in reference to the amount of

lipid in the serum sample.

Lipophilic “Fat loving” – describes compounds that can be easily dissolved or stored in lipids.

Man-made chemicals Chemicals that are produced by human activities, either intentionally or unintentionally,

and are not normally found in the environment. Also referred to as synthetic chemicals

or anthropomorphic (human-made) chemicals.

Metabolite A substance produced from another precursor substance through metabolic

transformation by enzymes or microorganisms in our bodies.

Naturally occurring

chemicals

Chemicals that are present or produced naturally in the environment. Some man-made

chemicals are also naturally occurring.

Opt-in consent Participants volunteer to take part in the research.

Opt-out consent Participants are contacted without volunteering to take part in the research and are

excluded when they declare they are unwilling to participate.

Periodic

biomonitoring

Repeated biomonitoring over more than one time point.

Persistent Resistant to degradation processes in our bodies or in the environment.

Pesticide A substance used to destroy insects or other organisms that may cause harm to crops or

animals.

Pharmacodynamics An area of study in pharmacology that explores the effects of substances on the human

body.

Pharmacokinetics An area of study in pharmacology that explores how the body responds to the presence

of a substance.

9

For details on the methodology please refer to the detailed technical document entitled “Northern Saskatchewan Biomonitoring Survey Report, 2019”. See: https://publications.saskatchewan.ca:443/api/v1/products/101375/formats/112049/download

The scope of this survey was to establish blood serum levels of various chemicals in women who were pregnant

and resided in the Northern Administrative District of Saskatchewan between April 2011 and April 2013.

1. Geographic: only residents in the Northern Administrative District of Saskatchewan from the former

Keewatin Yatthé, Mamawetan Churchhill River, and Athabasca Health Authorities plus the Village of

Cumberland House and Cumberland House First Nation were included;

2. Only females who were pregnant and had testing done during their pregnancy were selected;

3. Consent to use the sample was provided (direct or implied); and

4. Pregnancy testing had to be done between April 2011 and April 2013.

Pregnant women were selected for several reasons. The first is the known susceptibility of a developing fetus.

There are several chemicals known to have adverse effects on fetal development at relatively high maternal body

doses, but the effects on the fetus of new and emerging chemicals and low levels of some long standing chemicals

are less clearly defined. Second, targeting pregnant women was practical as there are routine blood tests

performed at the initial prenatal assessment. The serum specimens analyzed for biomonitoring were derived from

these blood draws - once the prenatal studies were completed if there was more than 1 ml of residual serum, the

sample was then eligible to be included for study.

- 1233 samples were collected

- 1086 consented to participate

- 841 samples were eligible for the study.

In total, the Roy Romanow Provincial Laboratory (formerly the Saskatchewan Disease Control Laboratory) received

1,233 serum samples between April 1, 2011 and April 8, 2013. Of these, 1,096 specimens were consented for

study inclusion; of those, 841 had a residual volume of 1mL and could be used for analysis. About 68% of the total

numbers of specimens from pregnant women in northern Saskatchewan were included in the pool. This is

relatively comparable to the Alberta sampling at 64% (28,484 samples drawn from 44,584 specimens collected).

The 841 samples were then grouped by geographic area into pools of at least 120 samples. This results in six

distinct collections of pooled serum samples.

METHODOLOGY

SCOPE

SAMPLE SELECTION


10

Figure 1: Biomonitoring communities and the resulting pools. Pool 1, 2, 3 = NW; Pool 4,5 = NE; Pool 6 = FarN; AHA

= Athabasca Health Authority, KYHR = Keewatin Yatthé Health Region, MCRRHA = Mamawetan Churchill River

Health Region, KTHR = Kelsey Trail Health Region

Information on specific individuals is not available and results cannot be linked to an individual, a specific

community (other than the pool area of groups of communities) or to a specific age group.

There were two phases of recruitment for this study over a two-year period. The first phase ran from April 1, 2011

to July 31, 2011. It included 189 specimens from northern pregnant women already at the Provincial Lab. Letters

to provide consent for the use of their residual blood specimen were mailed to the ordering physician to distibute

to the pregnant woman. Seventy-one (71/189) forms were returned and of those fifty-two (52) consented, six

declined and 13 forms were incomplete.

RECRUITMENT AND CONSENT

11

The second phase from August 1, 2011 to April 8, 2013 followed an extensive community awareness campaign

with the option for women to opt out. There were no refusals during this stage of the study.

Table 1: Sampling over two years

Phase One Phase Two

Date April 1, 2011 to July 31, 2011

(121 days)

August 1, 2011 to April 8, 2013

(616 days)

Sample Source Specimens already at the

provincial lab (189)

Pregnant women

Consent Letters sent to ordering

physicians to provide to women

Opt out at time of test (nil opted

out)

Sample Size 52

Of the 189 samples

- 71 forms returned

- 52 consented

- 6 declined

- 13 incomplete

1044

Samples with adequate serum (>

1 ml) and included in study pools 841 samples included across 6 pools

All of northern Saskatchewan was not sampled to the same extent. Some geographic areas were under sampled

compared to others. For example, those served by the Flin Flon Hospital have samples processed in Manitoba and

were not available for the study. In the first year, areas served by LaRonge Health Centre laboratory were not

included in the study samples, but were full participants in the subsequent year.

12

Chemicals were selected by reviewing data from similar biomonitoring studies, using criteria outlined in the

CHMS89, and consulting experts in the field.

The chemicals selected could be described asb:

Industrial and agricultural by-products;

Used in the manufacture of consumer goods;

Contaminants of potential concern either by The Stockholm Convention or in Federal regulations;

“Emerging” contaminants such as bisphenol A, parabens and phthalates (few studies available);

Naturally occurring in the environment though they may be found in different concentrations in different geographical areas. Some occur naturally in foods and some are required for the maintenance of good health, but can cause health concerns if people are exposed to large amounts.

b A similar set of chemicals were tested in Alberta as part of the Alberta Biomonitoring Study though the Saskatchewan study did include some

additional chemicals not included in the first phases of the Alberta study. A most recent Alberta study (Phase 3) included similar chemicals.

CHEMICAL SELECTION

Chemical Selection Approach:

Using criteria outlined in the CHMS89: known or suspected health effects related to the substance;

need for public health actions related to the substance;

level of public concern about exposures and possible health effects related to the substance;

evidence of exposure of the Canadian population to the substance; feasibility of collecting biological specimens in a [national] survey and associated burden on survey

respondents;

availability and efficiency of laboratory analytical methods; costs of performing the test; and,

parity of selected chemicals with other national and international surveys and studies.

Reviewing data from similar population biomonitoring studies;

Expert opinion.

13

Figure 2: Type of chemicals studied

There are advantages and disadvantages to using each biological matrix (such as urine, whole blood or serum). In

addition to these considerations, there are varying resource costs for collection and laboratory analysis of

chemicals in biological samples. In population level biomonitoring studies, choosing one matrix is considered to be

most cost-effective. Blood is typically considered a good reflection of the amount of the chemical that has

accumulated in the body or the internal body burden5. Thus, although blood serum may not be ideal for all

chemicals analyzed, it was the matrix selected for this study.

The chemical’s properities determine where the chemical will be found in the blood serum. Lipophilic (fat-loving)

chemicals are mostly found in the lipid rich portion of serum and are often described in reference to the lipid

weight of a serum sample. Some metals, such as mercury, prefer the blood cells and are not well measured in the

serum (which lacks blood cells). Therefore, it is necessary to consider the results found here with the realization

that blood serum was the matrix of choice (and not whole or lipid adjusted blood serum).

Several chemicals were analyzed at the Alberta Centre for Toxicology (Calgary, AB) including cotinine,

phytoestrogens and metals. Polybrominated diphenyl ethers (PBDEs) were analyzed in Prague, Czech Republic by

ALS Laboratory Group, while methylmercury was analyzed by ALS Laboratory Group in Sweden. The remaining

substances were evaluated in Edmonton, AB at the ALS Laboratory Group.

For the details of the analytical method for each chemical of interest, please refer to the full technical report.

The analysis of all Saskatchewan samples was provided by Alberta Health.

SELECTION OF BIOMONITORING MATRIX

LABORATORY ANALYSIS

14

The blood serum samples collected for this study were physically combined before analysis in a process called

“pooling”. The blood samples were pooled into six groups based on region (northeast, northwest and far north).

The pooling of blood samples has many advantages; however, it limits the information that can be derived from

the samples.

When individual blood samples are pooled together, the measured chemical concentration is a close estimate of

the arithmetic mean (average) of the concentrations that would have been in the blood of each individual.6 That

is to say, the concentrations for each pool are arithmetic averages of the pregnant women from a defined

geographic area.

In reality, most blood concentrations of chemicals across any given population tend to follow what is known as a

log-normal distribution.6 This is important because the best way to describe the “average” of such a population is

actually the geometric mean. 7

Standard deviation and standard error are important values that help add robustness to the information an

average, or mean, can provide. These were calculated and presented with all mean values. Both the standard

deviation and standard error provide an indication of the extent of the variability between the samples or the

range of results.

Pooling is important to increase the likelihood of detecting a concentration that is above either the limit of

detection (LOD) or the limit of quantification (LOQ). A challenge for assessing environmental chemicals in human

biomonitoring is that the concentrations of some chemicals are often so small that current techniques cannot

measure them. This is known as being below the limit of detection or the limit of quantification. When this

occurs, the presence of a particular chemical is unknown. When you pool together various samples you increase

the likelihood of measuring a substance if it is indeed there.

For the purposes of this study, the average across all six pools was determined only if at least five pools had

concentrations above the LOD or LOQ. 136 out of the approximately 283 chemicals met these criteria.

Unfortunately, due to the lack of randomization in the study design, we cannot generalize the findings of this study

to all pregnant women in northern Saskatchewan with certainty.

All analyses were conducted using Microsoft Excel (2003) with graphs generated using SigmaPlot (v12.5).

In order to compare the pools to each other and to pools in Alberta, statistical weighting was necessary. Some

pools had more individual samples than others, and to allow comparisons between these differing pools a

weighting factor was necessary. The detected concentration in a pool was multiplied by the number of its

samples. The sum of these products was divided by the sum of the number of samples (total participants),

resulting in a weighted overall mean. In this report, the combined northern values (weighted-arithmetic means)

will be identified as “mean” values.

STATISTICAL ANALYSIS

ANALYSIS AND LIMITATIONS

WEIGHTING OF CONCENTRATIONS

15

Biomonitoring provides valuable information, but the interpretation and application of that information should be

done ethically.

Formal ethical approval for this study was obtained from the University of Saskatchewan’s Research Ethics Board

(May 9, 2011 – Bio-RED-11-109). As well, approval was obtained from all four northern health authorities

(Athabasca Health Authority, Keewatin-Yatthé, Mamawetan Churchill River and Kelsey Trail Health Regions); and

the Northern Intertribal Health Authority (representing Prince Albert Grand Council, Meadow Lake Tribal Council,

Lac La Ronge Indian Band and the Peter Ballantyne Cree Nation).

ETHICAL CONSIDERATIONS

16

Biomonitoring is an important tool for understanding exposure to chemicals in the environment, but it is a tool

with limitations. These limitations are important to consider in the interpretation of the results. The “Limitations”

section of this document explores some of these in detail, but two key considerations include understanding the

ability to compare and the ability to interpret these results through a health lens.

Comparing Studies: The precision and accuracy of analytical instruments continue to improve with time. We now

can measure chemicals at very low concentrations, lower than ever before. As a result, the detection of a chemical

in one study and not in another may be the result of the changes in detection limits and may not reflect an actual

difference in exposure.

Chemicals and Health: For most chemicals or metals there are thresholds above which measurable health effects

are known to occur. Some substances are required for normal physiological functioning and thus too low amounts

can have detrimental effects. For other substances, chiefly carcinogens, but also some heavy metals such as lead,

there is no level of exposure below which health risk is considered zero. Some newer substances (such as

bisphenol-A) are still being studied and the health effects, if any, are unknown or unclear.

RESULTS

PREAMBLE

17

Six pooled samples were prepared based on the individual samples available. (Figure 3)

Figure 3: Infographic of how samples were assigned to geographic pools

* = limited sampling as most blood work done out of province

POOLED SAMPLES

18

A result is difficult to interpret without context to put value to that number. A challenge within the field of

biomonitoring is that due to the limited number of large scale biomonitoring projects and the constantly changing

technologies, this context is not always possible.

In this case, there are two key comparison studies from which comparisons are appropriate. The first is the

Alberta Biomonitoring Program3 and the second is the CHMS10. The Alberta Biomonitoring Program utilized serum

samples and the CHMS utilized whole blood, serum or urine. The comparison with the CHMS is possible when

serum samples were used. In cases where these two are not valid comparators, other sources will be presented.

There are circumstances, due to a variety of reasons (novel chemical, unique methodology, etc.), where no

comparison can be made.

Of the estimated 283 different chemicals that were studied, only 136 chemicals had at least five pools with

concentrations above the limit of detection or limit of quanitification. These chemicals met the criteria for further

statistical analysis. Where results were below the limit or detection or quantification, the concentrations for that

substance were either plotted without providing an overall mean value or were not reported at all.

COMPARISONS TO OTHER STUDIES

SERUM CHEMICAL LEVELS IN NORTHERN SASKATCHEWAN

19

Background

Cotinine is a breakdown product of nicotine, a chemical found in all tobacco products. Cotinine can be used to

estimate the exposure to tobacco smoke.

Individuals who are non-smokers are known to have serum cotinine concentrations less than 1-5 ng/mL (range

reflects variations across studies).11,12 Those who are heavily exposed to second-hand smoke have cotinine levels

in the range of 1-10 ng/mL, while active smokers have levels higher than 10 ng/mL. Any value above 10 ng/mL

strongly suggests regular tobacco smoking.

Notably, exposure to tobacco smoke is known to be associated with exposure to a wide variety of chemicals, many

measured in this study. The section “Smoking – An Important Source of Exposure and Risk” further explores how

this can influence the interpretation of some findings.

How can you be exposed to cotinine?

Tobacco smoke is the primary source of exposure to cotinine. Exposure can be via direct exposure to tobacco

smoke, but also as a consequence of second-hand smoke. Around 70% of the nicotine absorbed into the body via

exposure to tobacco is converted into cotinine.

What health effects have been linked to cotinine?

The health effects of cotinine are not of concern, but the health effects of tobacco smoke exposure are well

understood. These include a variety of life limiting and disabling diseases of the heart and respiratory tract.

Cancers of the lung, larynx and mouth are also known consequences of tobacco use. 13

Tobacco exposure during pregnancy has been associated with disruption in fetal development, pre-term birth and

adverse birth outcomes, and has also been linked with sudden infant death syndrome (SIDS).14,15 Babies born to

smoking mothers are known to be smaller than normal at the time of delivery.16

Result

Overall, serum cotinine concentrations measured among pregnant women in all pooled samples ranged from 46.8

ng/mL to 66.4 ng/mL (mean ± 95% confidence interval = 58.0 ng/mL ± 5.6 ng/mL). Non-smokers are normally

defined as having serum cotinine concentrations below 10 ng/mL, although often have concentrations below 1

ng/mL.11,12 Therefore, the concentrations of cotinine measured here indicate that many of the study participants

were smoking or exposed to significant amounts of second-hand smoke at the time of their blood sample

collection.

RESULTS BY CHEMICAL CLASS

ORGANIC CHEMICALS

COTININE

20

How do these values compare?

Saskatchewan Alberta

70 70

60 60

50 50

40 40

30 30

20 20

10 10

0 0

SK NW SK NE SK Far N SK OA

North Central South

Figure 4: Concentrations of cotinine in the blood serum of pregnant women in Saskatchewan (A) and Alberta (B).

The blue lines represent the limit of detection used in laboratory analysis. Estimates provided represent a 95%

confidence interval around the mean. SK OA = mean of the pooled samples from Northern Saskatchewan.

Nearly all pools from Saskatchewan were higher than the concentrations of cotinine identified in the Alberta study.

This suggests that smoking rates and overall tobacco exposure is markedly higher among the Saskatchewan

participants than those from Alberta.

Background

Phytoestrogens are naturally occurring compounds in plants and are consumed by humans in their diet. These

chemicals emulate estrogen and have been heralded as potentially protective against some medical conditions.17– 19

There are three major groups of phytoestrogens; isoflavones, lignans and coumestans.

How can you be exposed to phytoestrogens?

Common sources of isoflavones are legumes and soybean products, while lignans can be found in flaxseed, citrus

fruit, wheat, fennel, celery, and nuts.19 On average, Canadians consume less than 1 mg/day of isoflavones though

this may be higher in Asian populations.20

What health effects have been linked to phytoestrogens?

Scientific studies suggest that isoflavone products may reduce severe and frequent menopausal symptoms, as well

as lowered risk of osteoporosis, heart disease and some cancers.21,22 As isoflavones do act like estrogen in the

human body there is concern that some of them theoretically could lead to cancers associated with estrogen, but

at this time the scientific evidence does not support a need for concern.19,21

PHYTOESTROGENS

Co

nce

ntr

atio

n (

ng/m

L s

eru

m)

21

Result

Two isoflavones (daidzein and genistein) were measured in blood serum samples of pregnant northern

Saskatchewan women. Overall, the concentrations for daidzein ranged from 0.9 ng/mL to 2.0 ng/mL, while

genistein ranged from 3.0 ng/mL to 5.3 ng/mL. Pool 6 (far N) had the lowest blood serum concentration of both

daidzein and genistein whereas pool 2 (NW) had the highest.


Only the concentrations of daidzein in the Saskatchewan pools could be compared to the Alberta study. In

general, concentrations in Saskatchewan were comparable to those in Alberta and do not present any

concerns.

Background

Polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs), commonly known as

dioxins and furans, are relatively toxic and persistent environmental chemicals.

These compounds are not commercially manufactured or imported, but are produced as unintentional by-products

of several industrial processes (e.g. incineration, pulp bleaching, pesticide production), burning of municipal and

medical waste, backyard burning of household waste, wood burning and electrical power generation. Tobacco

smoke is also an exposure source for dioxins and furans. Dioxins and furans can also be naturally released during

forest fires and volcanic eruptions.

Dioxins and furans, once released into the air, can travel long distances before settling. This results in exposures

occurring far from the source.

How can you be exposed to dioxins and furans?

Most humans are exposed to dioxins and furans through diet or occupational exposures, with an estimated 90% of

total human exposure coming from food product of animal origin.23 Being that these classes of chemicals are so

widespread in the environment, all people have background concentrations in their body. As well, these

compounds accumulate in the human body and can take a long time to be excreted. These internal stores can

then be passed from mother to fetus during pregnancy or to an infant during breastfeeding.

What health effects have been linked to dioxins and furans?

Dioxins and furans are known to cause adverse health effects in humans. How likely or how severe depends on a

variety of factors including the chemical composition, dose, route of exposure, duration of exposure and timing of

exposure.

Some dioxins and furans have been clearly identified as a cause for cancer such as 2,3,7,8-tetrachlorodibenzo-p-

dioxin (TCDD) which has been classified as a Group 1 carcinogen (carcinogen to humans) by the International

Agency for Research on Cancer (IARC), while others have not.

DIOXINS AND FURANS

22

At high doses over short periods of time, such as what may occur in an occupational setting, dioxins and furans

may cause skin, liver and neurological problems, psychological effects, and impairment of the immune or

endocrine systems.24

Result

Out of 17 different dioxins and furans tested only OCDD and 1,2,3,4,6,7,8 – HpCDD were detected in all pools.


In general, OCDD concentrations were slightly lower than Alberta phase one values (2008). The same applied to

1,2,3,4,6,7,8 HPCDD. The remaining congeners could not be compared because of the number of Saskatchewan

pools below the limit of detection.

250

225

200

175

150

125

100

75

50

25

0

1.2

Saskatchewan


250

225

200

175

150

125

100

75

50

25

0

1.2

Alberta

North Central South

1.0 1.0

0.8 0.8

0.6 0.6

0.4 0.4

0.2 0.2

0.0


0.0

Age 18 - 25 Age 26-30 Age 31+

Figure 5: Concentrations of OCDD in blood serum of pregnant women in Saskatchewan and Alberta as

determined by lipid weight (A, B) and by total concentration in serum (C and D). The blue lines represent the

limit of detection used in laboratory analysis. Estimates provided represent a 95% confidence interval around the

mean.

Concentr

ation (

pg

/g lip

id)

Concentr

ation (

pg

/g s

eru

m)

23

Background

Polychlorinated biphenyls (PCBs) are human-made chemicals used for many decades as dielectric fluids in

transformers and capacitors in heat-exchange systems, as lubricants, plasticizers, and adhesives, as well as an

additive in sealants, plastics, paint, fire retardants, hydraulic oil, and pesticide extenders.25 Although PCB

manufacturing no longer occurs, PCBs were released into the environment during their manufacture, use and

disposal.

How can you be exposed to PCBs?

As PCBs do not degrade, they continue to exist in the environment long after manufacturing has ceased. Most

people continue to be exposed through their diet as oceans, freshwater bodies, pastures and agricultural soils

around the world contain low concentrations of PCBs. Once ingested, these compounds accumulate in the human

body and can take a long time to be excreted. Of particular concern is the transfer of these internal stores from

mother to fetus during pregnancy or to an infant during lactation.

Like dioxins and furans, PCBs are widespread and thus most people do have measurable concentrations.

What health effects have been linked to PCBs?

In terms of the health effects of being exposed to PCBs, the International Agency for Research on Cancer (IARC)

has determined that some of these chemicals are a Group 2A “probable carcinogen,” but at unknown exposure

levels over long periods of time. From studies on acute high level exposures (usually occupational) skin changes,

nail changes, limb swelling and neurological effects have all been identified.

PCBs have been somewhat evaluated in children of mothers who were exposed to remarkably high levels of PCBs.

The studies concluded that the children were at risk of several adverse health effects including low-birth weight,

immune system abnormalities, depressed motor skills and a decrease in short-term memory.26,27

Result

Of the 178 congeners of PCBs that were evaluated, 81 met the criteria for reporting (a sufficient number of pools

were above the limit of detection).

Overall mean concentrations of PCBs ranged from below the limit of detection to 249 ng/g.

Pool 1 most often had the highest concentration of PCB congeners compared to the other pools, particularly for

those congeners where the molecular size was smaller and had less chlorine in its molecular makeup. But, among

those PCBs with larger molecular sizes, the highest concentrations were seen more so in pools 4-6. Pool 6 had the

greatest concentration of the PCBs with the highest molecular weight. The penta- to hexa-chlorobiphenyl isomersc

were primarily detected in pools 3-5.

c These isomers (molecules with the same atoms, but configured differently) have 60% or higher chlorination (chlorine atoms per molecule)

POLYCHLORINATED BIPHENYLS (PCBS)

24


There were 8 PCB congeners detected and analyzed in both Saskatchewan and Alberta studies (PCBs 156, 158/129,

146, 170, 183, 187, 180, 199). Seven of these had similar levels between the two groups and for the PCB 158/129,

the mean concentration was lower in the Saskatchewan sample (mean ± 95% confidence interval: 0.25 ± 0.13 ng/g

lipid) than in the Alberta sample (mean ± 95% confidence interval: 0.62 ± 0.13 ng/g lipid).

Three other major studies in North American looked at PCBs; the Center for Disease Control and Prevention’s

(CDC) Fourth National Report on Human Exposure to Environmental Chemicals28, the First Nations Biomonitoring

Initiaitive29 (FNBI) and the CHMS10. The following graphic briefly describes the variation between the

concentrations of various PCBs examined in this study against the findings of these three previous studies. These

studies used geometric means and the FNBI and CHMS studies used plasma versus serum so caution is needed in

these comparisons.

Figure 6: Graphical comparison of the concentration of PCBs found in the Saskatchewan study against various

large scale biomonitoring initiatives

25

Background

Organochlorine (OC) pesticides are synthetic chlorinated hydrocarbons. Historically they have been used as

insecticides and fungicides. Now they are mostly strictly controlled by international agreements on persistent

organic pollutants (POPs) as they are known to persist in the environment, travel long distances and bioaccumulate

through the food chain.

How can you be exposed to OC pesticides?

Most humans are exposed to OCs through diet as most are now stored in the world’s soils and these chemicals

bioaccumulate through food sources. Less commonly, people are exposed to OCs through contaminated water or

air.

Once ingested, these compounds accumulate in the fat stores in the human body and can take a long time to be

excreted. Of particular concern is the transfer of these internal stores from mother to fetus during pregnancy or to

an infant during lactation.

Result

In the present study, the following OC pesticides were tested for in blood serum samples of pregnant women in

northern Saskatchewan (bolded chemicals were detected in some of the pools):

alpha-BHC

Oxychlordane

Endosulfan

2,4’-DDT

beta-BHC Aldrin 4,4’-DDD Trans-nonachlor

delta-BHC Heptachlor Epoxide 4,4’-DDT Mirex

gamma-BHC (Lindane) Dieldrin Methoxychlor

Octachlorostyrene 4,4’-DDE alpha-Chlordane

Heptachlor Endrin gamma-Chlordane

Hexachlorobenzene

Only endrin, 4,4-DDE, 4,4’-DDT, beta-BHC and hexachlorobenzene were detected in blood serum samples and not

in all pools, and only 4,4-DDE and hexachorobenzene were detected above detection limit in 5 pools and met the

statistical inclusion criteria of this report. Of the 22 pesticides tested only 4,4-DDE have levels detected in all

pools.

ORGANOCHLORINE PESTICIDES

26

Background

DDT is a broad-spectrum insecticide and has been used historically in Canada to control insects known to transmit

human disease such as mosquitoes. Over time, it became apparent that the breakdown products of DDT (4,4’-DDE

and 4,4’-DDD) were highly persistent in the environment.30 As a result, DDT cannot be used in Canada, although it

continues to be used in parts of the world as an affordable form of mosquito control.

DDT has the ability to travel long distances, leading to contamination in areas of the world where DDT was never

actively used, such as Canada’s far north.31 DDT and its breakdown products accumulate on soil and aquatic

sediments with bioaccumulation up through the food chain.

How can you be exposed to DDT and related compounds?

Humans are generally exposed to DDT through dietary consumption of contaminated foods. Once ingested, these

compounds accumulate in the body. Of particular concern is the transfer of these internal stores from mother to

fetus during pregnancy or to an infant during breast feeding.30

What health effects have been linked to DDT and related compounds?

Both the hepatic and nervous systems are known to be adversely affected by exposure to DDT in adults.31 The

effects on children and the developing fetus remain unknown.30

DDE is known to persist longer in the human body and, as such DDE is recognized as a better indicator of historical

exposures.32 DDE at background concentrations is not known to cause adverse health effects in humans, but at

very high doses (e.g. accidental chemical releases) it can cause respiratory problems, impairment of the immune

system, neurotoxicity, birth defects and reproductive toxicity. 33–36

Result

Blood serum concentrations of 4,4’-DDE ranged from 19 ng/g lipid to 138 ng/g lipid across the pools. Pool 2 (NW)

had the greatest concentration at 138 ng/g lipid, followed by pool 4 (NE) at 68 ng/g lipid. Pool 1 was below the

limit of detection. Pool 3 (NW) measured 19 ng/g lipid, pool 5 (NE) 26 ng/g of lipid and pool 6 (FarN) had a

concentration of 51 ng/g lipid.


The overall mean serum lipid concentration from the Saskatchewan participants is comparable to all age groupings

from northern Alberta and 18-25 year olds in central Alberta. Otherwise, the overall Saskatchewan mean was

lower than mean concentrations determined in the other Alberta groups. (see Figure 7) Also, the highest mean

concentration in AB was higher than the pool with the highest concentration in Saskatchewan.

The overall mean lipid concentration from the Saskatchewan study is comparable to women above the age of 31 in

Northern Alberta (mean ± 95% confidence interval: 55.94 ± 19.33 ng/g). Women in Southern Alberta have serum

blood concentrations of 4’4 DDE higher than that of women in Saskatchewan.

DDT AND RELATED COMPOUNDS

27

In the U.S. National Health and Nutrition Examination Survey (NHANES, 2003-2004 Fourth Report) (CDC, 2009), the

geometric mean of serum DDE concentrations in females were 241 ng/g of lipid and 1.5 ng/g of serum, and the

50th percentile was reported as 207 ng/g lipid. The Saskatchewan study mean is not a geometric mean thus direct

comparison is not possible, but this value does help suggest a range.


250 250

200 200

150 150

100 100

50 50

0

1.4


0

1.4

North Central South

1.2 1.2

1.0 1.0

0.8 0.8

0.6 0.6

0.4 0.4

0.2 0.2

0.0


0.0

North Central South

Figure 7: Concentrations of 4,4’-DDE in blood serum of pregnant women in Saskatchewan and Alberta as

determined by lipid weight (A, B) and by total concentration in serum (C and D). The blue lines represent the limit

of detection used in laboratory analysis. Estimates provided represent a 95% confidence interval around the mean.

For the Saskatchewan study, the LOD varied by pool.

Co

nce

ntr

atio

n (n

g/g

lip

id)

Co

nce

ntr

atio

n (n

g/g

seru

m)

28

Background

Hexachlorobenzene (HCB), also known as pentachlorophenyl chloride, was formerly (until the 1960s) widely used

as a synthetic fungicide. It had various other uses through history including fireworks, ammunition, synthetic

rubber, wood preservative and dialectic fluids.37

Today HCB is still released into the environment in small amounts as a byproduct of manufacturing, the use of

chlorinated solvents and pesticides, emissions from incinerators, and through long range transport in air and water

from other countries.37

Hexachlorobenzene is resistant to degradation and is able to persist in the environment for long periods of time.

Although it binds strongly to soil, it can leach over time, reintroducing the chemical into the environment long

after use has been stopped. It is known to bioaccumulate through aquatic species.

How can you be exposed to HCB?

Most people are exposed to HCB through diet. Once in the body, HCB accumulates in fatty tissue and is barely

broken down by the body’s metabolism. This chemical can cross the placenta and be excreted in breast milk.

What health effects have been linked to HCB?

Studies of HCB have found that background concentrations of the chemical are not associated with known adverse

health effects in humans. Nonetheless, high doses whether accidental or otherwise can cause severe health

effects including liver disease, neurotoxicity, immunotoxicity and skin lesions.37

Result

All pools except pool 5 (NE), did have measurable amounts of HCB ranging between 0.042 ng/g and 0.35 ng/g (lipid

serum weight: 7.5 ng/g to 71 ng/g). Pool 2 was higher than the rest with a concentration (lipid weighted) of 71

ng/g whereas the remaining pools had concentrations between 7.5 ng/g lipid weight and 27 ng/g lipid weight.


The overall means of the Saskatchewan study were comparable to that of the Alberta study. Pool 2 (NW) was

notably elevated both compared to other Saskatchewan pools and Alberta mean study concentration. (Figure 8)

NHANES 2003-2004 Fourth Report reported a geometric mean for females of 15.8 ng/g lipid, which is slightly lower

than the overall mean for the Saskatchewan study. The Saskatchewan study mean is not a geometric mean thus

direct comparison is not possible, but this value does help suggest a range.

HEXACHLOROBENZENE

29

Saskatchewan AB

80 80

70 70

60 60

50 50

40 40

30 30

20 20

10 10

0

0.40

0.35


0 OA

0.40

0.35

0.30 0.30

0.25 0.25

0.20 0.20

0.15 0.15

0.10 0.10

0.05 0.05

0.00


0.00 OA

Figure 8: Concentrations of hexachlorobenzene in blood serum of pregnant women in Saskatchewan and Alberta

as determined by lipid weight (A, B) and by total concentration in serum (C and D). The blue lines represent the

limit of detection used in laboratory analysis in the Alberta data. The limit of detection varied by pool in the

Saskatchewan data. Estimates provided represent a 95% confidence interval around the mean.

Concentr

ation (

ng/g

seru

m)

Concentr

ation (

ng/g

lip

id)

30

Background

Polybrominated diphenyl ethers (PBDEs) are flame retardants that have been used for decades in commercial

products. Three main types of manufactured commercial mixtures have been classically produced; penta-BDE,

octa-BDE and deca-BDE (names based on the average bromine content). Overall, there are 209 possible

congeners. Currently, commercial mixtures of penta-BDE and octa-BDE cannot be manufactured, sold or imported

in Canada.

PBDEs can be released into the environment from the products in which they are used. They are persistent

chemicals that can travel long distances.

How can you be exposed to PBDEs?

Humans are exposed to PBDEs primarily through dust at home and in workplaces, as the chemicals are released

from manufactured commercial products.38 It is possible to be exposed through diet, particularly from meat, dairy,

fish and eggs.39 PBDEs can be passed to the fetus or to infants by crossing the placenta or through breast milk.40

Those PBDE congeners that are smaller (1-5 bromine atoms per molecule) are better absorbed by the body, stay

longer in the body and are more toxic compared to larger ones.41

What health effects have been linked to PBDEs?

There are no definitive links between PBDEs and negative health outcomes in people. Research on rats and mice

demonstrated that PBDEs can affect thyroid and liver function, and high concentrations may affect neurological

function and the immune system. Based on animal studies, decabromodiphenyl ether (PBDE 209) has been

classified as a possible human carcinogens.42

Result

The following twelve PBDEs were tested for in the blood serum samples of pregnant women in northern

Saskatchewan with two of them not being detected (not bolded in figure below) in any of the northern

Saskatchewan pools (those bolded were detected):

POLYBROMINATED DIPHENYL ETHERS

Decabromodiphenyl ether (BDE 209) 2,2′,3,4,4′,5′,6-heptabromodiphenyl ether (BDE 183)

2,2′,4,4′,5,6′-hexabromodiphenyl ether (BDE 154) 2,2′,4,4′,5,5′-hexabromodiphenyl ether (BDE 153)

2,3,3’,4,4′,5′- hexabromodiphenyl ether (BDE 138) 2,2′,4,4′,6-pentabromodiphenyl ether (BDE 100)

2,2′,4,4′,5-pentabromodiphenyl ether (BDE 99) 2,2′,3,4,4′-pentabromodiphenyl ether (BDE 85)

3,3',4,4'-tetrabromodiphenyl ether (BDE 77) 2,3',4,4'-tetrabromodiphenyl ether (BDE 66)

2,2′,4,4′-tetrabromodiphenyl ether (BDE 47) 2,4,4'-tribromodiphenyl ether (BDE 28)

31

Figure 9: Contrasting the range of PBDE concentrations in the Saskatchewan study to the range of values for the

same in the Alberta study

Of the 12 congeners evaluated, there is no distinct overarching geographic trend in northern Saskatchewan. In general, pools 2-4 (NW, NW, NE) generally had the highest concentrations of PBDEs.


The Saskatchewan pools had a lower range of concentrations of PBDEs compared to the Alberta study values. BDE

99 and BDE 47 were about three times higher in the Alberta study.

Background

Perfluorochemicals (PFCs) are also referred to as perfluroalkyls or perfluorinated chemicals and have been used

for decades in industrial processes and commercial products. PFCs have primarily been used for stain repellent

formulations for textiles, paints, waxes, polishes, electronics, adhesives and food packaging.43

Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) are the two most commonly detected

isomers of PFCs. PFCs are found across the globe as they are able to travel long-distances and thus can be found in

areas where PFCs were not used (remote regions of the far north). PFCs are widely found in wildlife and human

blood due to long half-lives.44 They, like many other chemicals, are able to cross the placenta.45

How can you be exposed to PFCs?

Humans are exposed by the dust in homes and workplaces, and through diet (mainly fish and food products of

animal origin, and from food packaging leaching).43

PERFLUOROCHEMICALS

32

What health effects have been linked to PFCs?

PFCs have not been linked to human health effects, although there are a limited number of studies. Studies on

animals indicate that high doses of PFCs can affect development, reproduction and liver function.46,47 Recent

studies suggest that there may be an association between the concentrations of PFOS or PFOA in pregnant women

and infant birth weight.48,49

Result

The following eight PFCs were tested for in this study:

Bold = detected in all pools *= not detected in any pool

Only PFOS and PFOA were above the level of detection in all pools. Levels for all pools were lower than Alberta

levels Overall, there was no distinct trend across the pools for these chemicals, although pool 6 (Far N) had the

highest concentration for five of the eight isomers. Three of the eight isomers were not detected in any pool.

4.0

Saskatchewan

4.0

Alberta

3.5 3.5

3.0 3.0

2.5 2.5

2.0 2.0

1.5 1.5

1.0 1.0

0.5 0.5

0.0


0.0

North Central South

Figure 10: Concentrations of Perfluorooctanoate (PFOA) in the blood serum of pregnant women in

Saskatchewan (A) and Alberta (B). Saskatchewan data is presented for each of the six pooled samples, and for an

overall (OA) weighted arithmetic mean of the six pools. Alberta data is presented by mean concentrations

stratified by both age and region. The blue lines represent the limit of detection used in laboratory analysis.

Estimates provided represent a 95% confidence interval around the mean.

Perfluorooctanoate (PFOA)

Perfluorononanoate (PFNA)

Perfluorodecanoate (PFDA)

Perfluoroundecanoate (PFUA)

Perfluorododecanoate (PFDoA)*

Perfluorohexane sulfonate (PFHxS)*

Perfluorooctane sulfonate (PFOS)

Perfluorodecane sulfonate (PFDS)*

Perfluoroalkyl carboxylates Perfluoroalkyl sulfonates

Concentr

atio

n (

ng/m

L s

eru

m)

33

A

Saskatchewan

12 12

Alberta

10 10

8 8

6 6

4 4

2 2

0


0

North Central South

Figure 11: Concentrations of Perfluorooctane sulfonate (PFOS) in the blood serum of pregnant women in

Saskatchewan (A) and Alberta (B). Saskatchewan data is presented for each of the six pooled samples, and for an

overall (OA) weighted arithmetic mean of the six pools. Alberta data is presented by region with mean of all the

pools that were analyzed from each region. The blue lines represent the limit of detection used in laboratory

analysis. Estimates provided represent a 95% confidence interval around the mean.


Only PFOS and PFOA had enough pools with concentrations above the limit of detection to allow for a mean to be

determined in the Saskatchewan study. In contrast, in Alberta 8 of the 9 assessed isomers reached this threshold.

In the case of these two identified isomers, the weighted arthimetic mean of the study pools in Saskatchewan was

lower than all Alberta mean values (study groups were stratified by age and geographic location).

In the CHMS Cycle 210 the geometric means of female participants aged 20-79 was 2.0 (1.8 to 2.2) µg/L plasma for

PFOA and 5.7 (4.9 to 6.6) µg/L plasma for PFOS (units are equivalent to our study) and Health Canada indicated

that these levels were not a concern for human health. The northern Saskatchewan weighted arithmetic means

were lower than these values for PFOS and PFOA. The CDC’s NHANES Fourth Report PFOS reported a geometric

mean of 18.4 µg/L plasma of PFOS in the general female population 12 years of age and older.28

B

Concentr

atio

n (

ng/m

L s

eru

m)

34

Background

Bisphenol-A (BPA) is a synthetic chemical used in the manufacturing of plastics and resins that are found in food

and beverage bottles, medical devices, dental fillings and sealants and thermal paper products. Health Canada has

concluded that current dietary exposure to BPA through food packaging uses is not expected to pose a health risk

including to newborns and young infants. However, Health Canada, as a precautionary measure, is working with

industry to reduce BPA in food packaging especially for infants and newborns. 50

How can you be exposed to BPAs?

Most humans are exposed to BPAs as the chemical leaches from these plastics and resins, contaminating foods and

beverages.51 There is also evidence emerging that BPAs can leach from landfills and enter into the surrounding

environment.52 Once BPA is in the body, it is able to cross the placenta53 and accumulate in breast milk.54

What health effects have been linked to BPAs?

The potential health effects of BPA on humans have yet to be determined due to it being a relatively new

substance and few human studies.55 Results of animal studies suggest that BPA may act like the human hormone

estrogen and may be linked to developmental and reproductive issues, neurotoxicity, ovarian dysfunction and

recurrent miscarriages in animals.

Result

Bisphenol-A was not detected in any of the northern Saskatchewan pools.


Bisphenol A was detected in over 25% of the pools in the Alberta study, whereas bisphenol-A was not detected in

any of the Saskatchewan pools.

Notably, the test for bisphenol A performed in Alberta differed from that in the Saskatchewan study. This

difference resulted in a higher limit of detection in the Saskatchewan study (a 20-fold difference), which meant all

pools with concentrations below 0.20 ng/mL were considered non-detectable (conversely this threshold was ~0.01

ng/mL for the Alberta pools). It is important to note that the Alberta samples were collected before the

prohibition of BPA in baby bottles and similar plastic products, while the Saskatchewan samples were collected

after this change in regulation. Therefore it is possible that women in Saskatchewan were exposed to a smaller

amount of BPA due to regulatory changes.

A single study performed in the Eastern Townships in Canada found a mean serum concentration of 3.83 ng/mL

across the women in their study.56 The Canadian Health Measures Survey and the First Nations Biomonitoring

Initiative measured BPA levels in urine.

BISPHENOL-A

35

Background

Octylphenol (OP) refers to a group of chemicals used for surfactant manufacturing. In Canada these are used in

the development of detergents, industrial cleaners, paints, textile mills and the pulp and paper industry.

How can you be exposed to octylphenol?

Humans are primarily exposed through diet (these chemicals can bioaccumulate through the food chain) and

exposure to the trace amounts of OPs in water and air.57,58 OPs can cross the placenta and be passed on through

breast milk.

What health effects have been linked to octylphenol?

The health effects of octylphenol from background exposures are unknown. Concerns exist due to the potential

estrogenic effects, but at this time research into these effects continues.59

Result

Octylphenol was detected in all pools with concentrations ranging from 13.7 ng/mL to 19 ng/mL.

Table 2: Concentrations of serum octylphenol by pool

Wet

weight

(ng/mL)

Pool 1

NW

N=162

Pool 2

NW

N=138

Pool 3

NW

N=120

Pool 4

NE

N= 130

Pool 5

NE

N=150

Pool 6

FarN

N=141

Mean (95% CI)

Octylphenol

19

15

18.7

13.7

18.7

18.2

17.3 (15.5-19.1)


There is presently no comparable value for serum from the Alberta study.

Two small studies can be used - the first of women between 55 and 75 years of age in Wisconsin and another of

maternal serum samples of women in the Yantze River Delta region. The first reported a median (of detectable

values) of 1.78 ng/mL60 and the second a median or 470 (Interquartile range = 280-660) ng/mL.61 The

Saskatchewan values fall well below the Chinese study, but all pools do measure above the Wisconsin study.

Unfortunately, there are no large scale studies against which to compare.

OCTYLPHENOL

36

Background

Mercury is a widespread, naturally occurring metal that is found across the globe. It exists in three forms;

elemental, inorganic and organic. Elemental and inorganic forms of mercury are released into the air and water

through a variety of human processes including burning of fossil fuels, mining, smelting, and other industrial

practices. It is also released through natural processes such as erosion, volcanoes and forest fires.62 It is discussed

in the Inorganic Chemicals section.

Methylmercury (MeHg, CH3Hg, “organic mercury”) is of particular concern as it is the most toxic form of mercury

to humans and its ability to adversely affect health is well understood. Of all the forms of mercury, it has the

greatest ability to cross the blood brain barrier and enter the brain - the nervous system is very sensitive to

mercury.63 It is also able to cross the placenta.64

How can you be exposed to methylmercury?

Methylmercury (MeHg) is often produced from other forms of mercury through natural biological processes by

bacteria in aquatic sediments. It efficiently bioaccumulates through the aquatic food chain.The greatest source for

humans is through dietary consumption of certain fish and seafood.

Large predatory fish such as shark, large tuna, swordfish, marlin and king mackerel have been identified as being of

particular concern.66 Fish and seafood are good sources of protein, omega-3 fatty acids, minerals and vitamins

(including vitamin D) that promote healthy hearts, healthy growth and brain and eye development of infants and

children. Health Canada recommends that all Canadians, including pregnant women and children, eat at least two

servings of fish per week to benefit from the nutrients found in fish and seafood but to limit the consumption of

fish known to have higher mercury levels.67

In order to minimize mercury exposure, Health Canada has guidelines advising Canadians to limit their

consumption of those higher mercury fish to a maximum of 150 grams per week. Pregnant women and children

have more stringent guidelines. Most importantly Health Canada promotes consuming a wide variety of fish and

seafood.68 Saskatchewan has additional consumption guidelines available for sports fish based on the lake, the

type and size of the fish recommendations and whether it is for the general population or for women of child

bearing age and for children.69

What health effects have been linked to methylmercury?

Methylmercury is a known neurotoxin. At moderate to high doses (such as in the case of a poisoning) MeHg is

known to cause adverse effects to both the motor and sensory nervous systems. If pregnant women are exposed

to high amounts, then there is risk of fetal abnormalities and neurotoxicity.64

At moderate to low doses, there are more subtle neurodevelopment effects that can result from MeHg exposure,

including memory loss, attention deficits, language issues and visual-motor skill problems in childhood.64

METHYLMERCURY

37

Result

Methymercury was detected in four of the six pools. Pool six had the highest concentration of methymercury at

0.3 ng/g. The detectable concentrations ranged from 0.1 ng/g to 0.3 ng/g.


Of the pools that were above the LOD, pools 1 (NW), 2(NW) and 4(NE) had values comparable to the detected

range in Alberta. Pool 6 (far N) had a concentration higher than the mean concentrations determined in the

Alberta study (where groups were defined by age and geographic region) (Figure 12). Although Health Canada has

set guidelines for methylmercury in whole blood, it is difficult to interpret the present results in this context

because serum is known to contain only a small fraction (5%) of total methylmercury.

0.35

Saskatchewan

0.35

Alberta

0.30 0.30

0.25 0.25

0.20 0.20

0.15 0.15

0.10 0.10

0.05 0.05

0.00

SK NW SK NE SK Far N

0.00

North Central South

Figure 12: Concentrations of methylmercury in the blood serum of pregnant women in Saskatchewan (A) and

Alberta (B). The blue lines represent the limit of detection used in laboratory analysis. Estimates provided

represent a 95% confidence interval around the mean.

The recent First Nations Food, Nutrition and Environment Survey in Saskatchewan reported on mercury exposures

as measured in hair samples and calculated through dietary estimates, to be low and not a health concern for

Saskatchewan First Nations generally; however, there were some exceedances of Health Canada guidelines among

women of childbearing age living in the Boreal Shield ecozone of the province.65

Con

ce

ntr

atio

n (

ng

/g se

rum

)

38

Background

Phthalates are a class of industrial chemicals used in plastics to make them more flexible and harder to break.70 It

is estimated that nearly 18 billion pounds of phthalates are produced and used each year for a variety of purposes

including PVC flooring, printing inks, personal care products and medical equipment.71

How can you be exposed to phthalates?

Exposure usually occurs by eating or drinking foods stored in containers that were made using phthalates. There is

also the possibility of being exposed by inhaling dust that contains phthalate particles (more common in

children).70 Phthalates can be passed through breast milk to the infant.72

What health effects have been linked to phthalates?

Phthalates are considered endocrine disruptors or hormonally active agents (HAAs) because of their ability to

interfere with the body’s natural hormones. At this time, most of the studies of phthalates have been on animals

and there is evidence to suggest these chemicals can cause developmental abnormalities such as cleft palates and

malformations of the genital tract (particularly in males).72

At this time there is more research needed into the effects of background environmental exposure to humans.

Result

Ten phthalate metabolites were tested for in the blood serum samples of select pregnant women in northern

Saskatchewan. Only four were detected as bolded below:

Mono-(2-ethylhexyl) phthalate (MEHP) was detected, but upon review it was discovered that sample containers

used for storage and analysis were plastic which resulted in falsely elevated values. As a consequence, MEHP was

removed from the final analysis.

There are no distinct geographic trends across the metabolites.

PHTHALATES

Mono-(2-ethyl-5-hydroxyhexyl) phthalate Monobenzyl phthalate

Monoisononyl phthalate Monocyclohexyl phthalate

Mono-(2-ethyl-5-oxohexyl) phthalate Monoisobutyl phthalate

Mono-n-octyl phthalate Monoethyl phthalate

Mono-(2-ethylhexyl) phthalate Monomethyl phthalate

39

Table 3: Concentration of detected pthalate metabolites by pool

Pthalate ng/mL Pool 1

NW

N=162

Pool 2

NW

N=138

Pool 3

NW

N=120

Pool 4

NE

N= 130

Pool 5

NE

N=150

Pool 6

FarN

N=141

Mean

(95% CI)

Monoethyl

phthalate

Serum 6 4.3 6.1 5.3 4.2 2.5 4.7 (3.6-5.8)

Monoisobutyl

phthalate

Serum 15 13.6 16.9 13.4 13.9 12.8 14.2 (13.1-15.3)

Monobenzyl

phthalate

Serum 1.4 0.9 1.8 1.5 2.1 1.2 1.5 (1.2-1.8)


There is presently no comparable value for serum or blood from the Alberta study or from other data sources.

Background

Parabens are widely used preservatives in cosmetics and personal care products. All commercial parabens are

man-made, although parabens do occur naturally in certain fruits.73

How can you be exposed to parabens?

Most people are exposed to parabens through the use of personal care products, consumer foods or

pharmaceuticals that contain parabens.

What health effects have been linked to parabens?

In animal studies, parabens have been found to weakly behave like estrogen. There is a known link between

estrogen and some cancers (breast), and there is a theoretical concern with chemicals that act like estrogen.

Several expert reviews73,74 have demonstrated that parabens are safe at the concentrations currently found in

cosmetics.

PARABENS

40

Result

The following five paraben isomers were tested for in the blood serum samples of select pregnant women in

northern Saskatchewan. Those bolded were detected:

Three of the five tested paraben isomers were detected (Table 4). Pool 4 (NE) consistently had the lowest

concentration of the detected isomers.

Table 4: Concentrations of paraben isomers by pool

Paraben ng/mL Pool 1

NW

N=162

Pool 2

NW

N=138

Pool 3

NW

N=120

Pool 4

NE

N= 130

Pool 5

NE

N=150

Pool 6

FarN

N=141

Mean (95% CI)

Methyl

Paraben

Serum

12

14

9.7

4.5

7.6

8.2 9.4 (6.7-12.1)

Ethyl

Paraben

Serum

2.6

<LOD

<LOD

<LOD

1.6

1.7

N/A

Propyl

Paraben

Serum 1.9 2.4 1.48 0.9 1.5 1.4 1.6 (1.2-2.0)

where LOD = limit of detection


There is no value presently to compare in the Alberta study and no other comparable source is available for serum

or blood.

Propyl Paraben

Benzyl Paraben Ethyl Paraben

Butyl Paraben Methyl Paraben

41

Mineral micronutrients Non-micronutrients

The following trace metals were analyzed in the participant blood serum samples:

Boron Magnesium Aluminum Mercury

Cobalt Molybdenum Antimony Platinum

Copper Nickel Arsenic Strontium

Iron Selenium Barium Thallium

Manganese Zinc Beryllium Titanium

Cadmium Tungsten

Cesium Uranium

Chromium Vanadium

Lead

Mineral micronutrients are those metals and minerals that are required in small amounts to maintain the health of

a living organism.

The results of this study indicated that the following trace elements had more than 1 pool below detection limits:

Uranium, thallium, tungsten, cadmium, arsenic, chromium, vanadium, titanium, beryllium and boron. As such, no

aggregate statistics were performed on these trace metals and findings are not be presented here for all of these.

Background

Aluminum is the third most abundant chemical element in mineral rocks and is widespread in the environment.75

It has ideal chemical and physical properties and is used in many products such as automobiles, wiring, electrical

devices, paints, antiperspirants, cooking accessories, as well as additives in pharmaceuticals and food. 76

Aluminum sulphate is also commonly used in water treatment.

How can you be exposed to aluminum?

Aluminum can be released into our environment (air, water and soil) through the use or disposal of aluminum

containing products, as well as through various industrial processes. Most people are exposed to background

concentrations of aluminum in food, water or soil, or inhalation of air or dust containing trace amounts of the

metal. 75

TRACE METALS AND MINERALS

TRACE METALS (NON-MICRONUTRIENTS)

ALUMINUM (AL)

42

What health effects have been linked to aluminum?

Background concentrations of aluminum have been recognized as having no ill effects on humans. Most ingested

aluminum is not absorbed and is excreted in the feces, and that which is absorbed is excreted in the urine. 75

At high doses (such as in the case of accidental releases or unusual occupational exposures) aluminum is a known

neurotoxin, renal toxin and may causes respiratory problems, vomiting and/or rash.75

Result

Concentrations of aluminum ranged from 6.4 µg/L to 15 µg/L across all pools. (Figure ).

Saskatchewan AB

25 25

20 20

15 15

10 10

5 5

0 0

SK NW SK NE SK Far N SK OA OA

Figure 13: Concentrations of aluminum in the blood serum of pregnant women in Saskatchewan (A) and Alberta

(B). The blue lines represent the limit of quantification used in laboratory analysis. Estimates provided represent

a 95% confidence interval around the mean.


The overall mean serum concentration (± 95% confidence interval) measured was 22.3 ± 0.9 µg/L in the Alberta

study, thus all Saskatchewan pools were lower than this value. Although, the detection limit was quite different

between the two studies which can reduce the ability to reliably compare the two studies.

Background

Antimony is a naturally occurring metal. It can be released from the weathering of rocks and minerals and exists

naturally as various compounds used for a variety of alloys.75 It can be used to manufacture ceramics, glass,

pigments, flame retardants, paints, semi-conductors, fireworks, batteries and some plastics.76

ANTIMONY (SB)

Co

nce

ntr

atio

n (

g/L

se

rum

)

43

Antimony is released into the environment through disposal of these products or through a variety of mining and

industrial processes. It can also enter the water system naturally through soil erosion 77

How can you be exposed to antimony?

Exposure to antimony can occur through ingestion of food, and less so through inhalation or dermal contact with

substances containing antimony (including drinking water).79 People may be exposed to higher antimony

concentrations in occupational settings.77

What health effects have been linked to antimony?

Background exposures to antimony are not known to cause any ill health effects in humans.77 In cases where

doses are high such as in unusual occupational exposures or accidental releases, antimony may cause adverse

health effects of the respiratory, cardiac or digestive systems.77

Result

Overall, mean concentrations for antimony ranged from 3.3 µg/L to 3.8 µg/L (mean ± 95% confidence interval: 3.5

µg/L ± 0.2 µg/L). There was no apparent difference between regions.


Mean concentrations in the Alberta study are comparable to the mean concentration of the Saskatchewan study.

No single Saskatchewan pool varied from the ranges of mean values in the Alberta study.

Background

Arsenic is a naturally occurring element widely found in the earth’s crust. In nature arsenic can combine with

other elements to form inorganic arsenic compounds, or it can combine with carbon and hydrogen to form organic

arsenic compounds.80 There are trace amounts of arsenic in all living matter.

Inorganic arsenic is often used to make pressure-treated lumber (in the form of copper chromated arsenic (CCA))

for use in industrial applications but is no longer used in residential lumber. Some arsenic compounds are used as

pesticides, but uses are restricted. Some organic forms of arsenic are used in poultry feed as a form of disease

protection. There is a role for some elemental metalloids in ammunition, solders and lead-acid storage battery

grids.81

How can you be exposed to arsenic?

Background exposure can occur from a variety of pathways. For most Canadians, the primary source of exposure

to arsenic is food, followed by drinking water, soil and air. Geographical variation in naturally occurring soil

concentrations of arsenic can result in variations in population exposure.

In the Canadian Total Diet Survey, marine fish, fresh water fish, and canned fish contribute most to the total

arsenic intake from food.82 Individuals with higher fish and seafood consumption will have higher exposures to

ARSENIC (AS)

44

total arsenic; however, fish and other seafood contain mostly organic forms of arsenic which is essentially non-

toxic.

Human exposure to inorganic arsenic can also be from smoking tobacco.83

What health effects have been linked to arsenic?

Inorganic arsenic is well absorbed by the gastrointestinal tract, and to a lesser degree through inhalation. It is

poorly absorbed through skin.81

Inorganic arsenic can contribute to human cancers (gastrointestinal tract, kidneys, liver, lungs and skin) in cases of

long-term high level exposures. Short term exposures of very high levels of inorganic arsenic are also known to

cause ill health by disturbing the gastrointestinal, neurologic and dermal systems.84

Organic forms of arsenic are not known to cause ill health in humans.

Result

Serum arsenic concentrations were above the limit of detection in pools 1 (NW), 4 (NE) and 6 (Far N). The

concentrations ranged from 0.07 µg/L to 0.15 µg/L. Pool 6 had the highest concentration and pool 1 the minimum

detected (Figure 14). The results represent the total amount of arsenic and do not describe the quantity of

inorganic versus organic forms of the metal found in these blood serum samples. Higher levels in the Far N pool

may be a result of the essentially non-toxic organic form common in fish.

0.16

0.14

0.12

0.10

0.08

0.06

SK NW SK NE SK Far N

Figure 14: Serum concentration of arsenic in pregnant women in Saskatchewan. The blue line represents the

analytical limit of quantification.


There is no value to compare in the Alberta study and no other comparable source is available for serum values.

The First Nations Biomonitoring Initiative measured arsenic in blood (not serum) and urine so comparison is not

possible.29

Co

nce

ntr

atio

n (

g/L

seru

m)

45

Background

Barium is a naturally occurring element found often in sedimentary and igneous rocks. It is most often found in

compounds (such as salts) rather than in its free elemental state.85 No known barite deposits occur in

Saskatchewan or Alberta.

Barium compounds are used or found in many products including drilling mud, bricks, glass, rubber, florescent

lamps and are used forimaging-ray diagnosis of the digestive tract. 86

How can you be exposed to barium?

Background exposure to barium in the general population occurs through absorption, ingestion and inhalation of

food, water, soil and/or air containing trace amounts of barium. Barium is released into the environment by using

or disposing of products that contain barium as well as mining, burning coal and fossil fuels and other industrial

processes.86 Barium sulfate which is used as a benign aid to x-ray diagnosis, is not absorbed into the blood and is

non-toxic to humans.

Some foods have higher amounts of barium - milk, flour, potatoes and some cereals and nuts. Nonetheless, most

foods contain less than 0.0002 mg/g of barium.85 It is estimated that the average person consumes about 0.03

mg/day of barium. 87

Barium may be excreted in breast milk.

What health effects have been linked to barium?

Background concentrations of barium in humans are not known to cause ill health effects.86

The absorption of barium into the body via the gastrointestinal tract and lungs depends on the type of barium

compound, contents within the gastrointestinal tract and age of person.85,86 Barium salts, such as barium sulphate,

that are less water soluble cause fewer negative health effects. Soluble barium salts are extremely toxic at high

doses causing arteries to constrict, seizures, paralysis and in some cases death.85 Other symptoms of acute barium

toxicity include gastrointestinal issues.85

Result

Pool concentrations for barium ranged from 2.6 µg/L to 3.5 µg/L (mean ± 95% confidence interval: 3.2 µg/L ± 0.3

µg/L). There was not much variation between pools.


Saskatchewan pool concentrations were all lower than those detected in Alberta (Alberta was stratified by

geographic region and age).

BARIUM (BA)

46

Background

Cadmium is a soft metal, often a by-product of refining metals such as zinc, copper, or lead. Cadmium is used in

electroplating, as well as the manufacture of plastics and pigments and, to a lesser extent, fungicides, nuclear

reactors, television, batteries, motor oils and in rubber production. 88

Cadmium can enter the food chain through the soil into plants.89 It can also enter into water sources through

industrial and municipal wastes, and leaching from soldering, and black or galvanized pipes.88

How can you be exposed to cadmium?

In non-smokers, cadmium exposure often occurs through ingestion of foods containing cadmium. It can

accumulate in aquatic species and agricultural crops. Leafy greens, vegetables, potatoes, grains and peanuts are

primary food sources of cadmium, although individuals who consume shellfish and organ meats (kidney and liver)

regularly may have elevated exposures.88,89

An important source of cadmium is through inhalation of tobacco smoke;90 a single cigarette contains about 1 to 2

μg of cadmium. Those who smoke have kidney levels of cadmium twice that of non-smokers.88

Indigenous smoking rates are approximately double that of the general non-Indigenous population in Canada.91 As

a consequence, cadmium exposure is higher in this group. As well, cadmium is taken up by lichens and other

plants such as willow, thereby accumulating in the organs (kidney and livers) of herbivorous animals that are then

consumed by Indigenous populations.92 Several studies of Canadian First Nations show that cadmium levels were

associated with the number of cigarettes smoked by humans in the area, but not associated with traditional food

consumption.92,93 A study revealed cadmium levels in moose liver in northern Saskatchewan94,95 were lower than

levels found in southern Saskatchewan, Ontario96, Yukon97, northern British Columbia98, Manitoba99 and Alaska100.

What health effects have been linked to cadmium?

Cadmium when entering the body is deposited in all major organs, but the liver and kidney are the most common

sites. Cadmium can stay in the body for years. As a consequence, chronic low-level exposures can lead to a build-

up of cadmium in the body, and kidney damage can result. Long-terms exposures have also been linked to skeletal

changes, lumbar pain and myalgias.88

Cadmium has been determined to be a human carcinogen by the International Agency for Research on Cancer.89

Result

All pools were below the limit of quantification of 0.05 ug/L.


There is no value to compare in the Alberta study and no other comparable source is available for serum values. It

is not possible to compare the Saskatchewan data directly with the blood cadmium levels determined in the

Canadian Health Measures Survey, the Canadian survey found that cadmium levels were strongly associated with

smoking, while the impact of diet was modest to small

CADMIUM (CD)

47

Background

Cesium is naturally occurring and enters the environment from natural processes such as weathering of rocks and

minerals.101 In the environment, cesium exists as either the stable isotope form of cesium (134Cs) or as a compound

(hydroxides, carbonates, iodides and bromides).

Cesium compounds are used in a variety of products including alkaline storage batteries, photoelectric cells, optical

instruments, glasses and atomic clocks.101 Cesium is mined in southeastern Manitoba for the production of a

biodegradable lubricant fluid used in oil drilling.102 Use or disposal of cesium containing products, as well as mining

and some other industrial processes can release cesium into the environment (air, water and soil).

How can you be exposed to cesium?

Background exposure to cesium is primarily through ingestion or inhalation of food, water, soil and air containing

trace amounts of cesium. Tea and coffee contributes to the largest consumption of cesium by the average

Canadian adult. Yeast, herbs and spices have high concentrations of cesium but these are generally only

consumed in small amounts.82 Lichens are also high in cesium which is a major dietary source for caribou. Studies

in lichen and caribou in the Northwest Territories103 and Saskatchewan show relatively high levels of stable

cesium.104 Cesium chloride is sold as an oral alternative cancer therapy though there is no evidence of

effectiveness and this high dose use can cause serious heart rhythm problems.105

What health effects have been linked to cesium?

Background concentrations of cesium are not known to cause any ill health effects in humans, but long term

exposure studies of cesium are limited.101 High doses of cesium chloride as an alternative cancer therapy can

cause heart arrhythmias.

Result

The cesium analyzed in this study represents the amount of cesium 133 (stable or non-radioactive cesium) and is

not a measure of total cesium as other isotopes were not analyzed.

Overall, mean concentrations of cesium in the six pools ranged from 0.3 µg/L to 3.5 µg/L (mean ± 95% confidence

interval: 0.9 µg/L ± 1.0 µg/L). Pool 6 (Far N) had the highest concentration of cesium (3.46 µg/L).

The reasoning behind the elevated concentration of cesium in the far north (Pool 6) at this time is unclear. There

are behavioural variations in this area that include more subsistence hunting and consumption of country foods

and possible geological crustal variations, however, the concentrations measured here only indicate body burden,

so sources of exposure can only be speculative at this time.

CESIUM (CS)

48


Cesium levels in pools 1-5 were very similar both with Saskatchewan and when compared to the Alberta mean

concentrations (grouped by geography and age). Pool 6 when compared against all mean cesium concentrations in

Alberta is orders of magnitude greater (Figure 15).

Saskatchewan

4 4

Alberta

3 3

2 2

1 1

0 0

SK NW SK NE SK Far N SK OA North Central South

Figure 15: Concentrations of cesium in the blood serum of pregnant women in Saskatchewan (A) and Alberta (B).

Saskatchewan data is presented for each of the six pooled samples, and for an overall (OA) mean of the six pools.

Mean concentrations stratified by both age and region are presented for Alberta. The blue lines represent the

limit of quantification used in laboratory analysis.

Background

Chromium occurs naturally in the environment and released by weathering of rocks and minerals, and volcanic

eruptions. Naturally occurring chromium has three states; metallic (Cr(0)), trivalent (Cr(III)) or hexavalentCr(VI).

Hexavalent chromium is most commonly found in surface waters and aerobic soil environments. Trivalent

chromium is usually in sediments and wetlands. Hexavalent chromium salts are more able than trivalent

chromium to be mobile due to being more soluble.107

Chromium compounds are used as wood preservatives, in metal plating, for leather tanning, as a catalyst, and in

pigments, paints and fertilizers. Chromium is naturally released into environment from volcanoes, forest fires and

marine aerosols.108

Chromium is released into water by effluent of tanneries, pulp and paper mills, and cement and fertilizer plants

and other industrial sources.109 It is released into the air by aerosol.110 Chromium is not known to bioaccumulate

in aquatic environments.108

CHROMIUM (CR)

Age 18 - 25

Age 26-30

Age 31+

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How can you be exposed to chromium?

The general population is most likely to be exposed to trace levels of chromium in food. Low levels of the non-

toxic form of chromium (chromium III) occur naturally in a variety of foods, such as fruits, vegetables, nuts, and

meats. However, the general population is exposed to the more toxic forms of chromium (Cr VI) most often by

ingestion of contaminated foods, but also through tobacco smoking and contact with older forms of pressure

treated lumber (with chromated copper arsensate).109

What health effects have been linked to chromium?

Health effects of chromium depend on the dose, the length and timing of exposure, the environment, the species

of chromium and other physiological factors. Chromium (III) is an essential micro-nutrient, while chromium (VI)

can be toxic.

Background concentrations of hexavalent Cr is not known to cause any adverse health effects.109 Long-term

exposure of high doses of hexavalent chromium may cause health effects such as eye, skin, mucous membrane

and nose irritation as well as digestive system problems.109 Cr (VI) can accumulate in tissues such as the lymph

nodes, liver, spleen, kidneys and lungs as it can, unlike Cr (III), cross into cells.

Result

Concentrations for all pools were below the limit of quantification (0.5 µg/L).


The mean concentration of blood serum chromium in the Alberta study was 1.5 ± 0.7 µg/L.

Studies have found that serum and whole blood sampling cannot be compared due to chromium’s interaction with

red blood cells, and thus no other comparable studies are available.111

Background

Lead is a ubiquitous, naturally occurring heavy metal used in both industrial and commercial products (paints,

gasoline, plumbing fixtures, storage batteries, leaded glass, leaded crystal, radiation shielding, bullets, shot, and

fishing weights).112 Lead is released into homes and environments with the use or disposal of such products, as

well as a consequence of mining and other industrial processes.

Lead can enter into the environment through air plumes from smelters and emission stacks or mobilization in the

soil (under the right circumstances) and contamination of ground and surface water. Lead can also enter into the

water system through the leaching of lead containing pipes.112,113

How can you be exposed to lead?

Humans can be exposed to lead in a variety of ways. Lead containing dust can be found in homes and workplaces,

particularly older homes where lead-based paints were used. Drinking water that is delivered through older water

pipes containing lead is a known source of lead exposure.114

LEAD (PB)

50

Tobacco smoking is an important source of lead exposure among smokers.115 Lead shot shells and bullets used in

hunting have been identified as a source of exposure for those who consume game animals and birds. Indigenous

populations may be particularly vulnerable due to the higher degree of consumption of game animals and birds. 116–122

Lead can be detected in breast milk and may cross the placenta as early as 12 weeks into gestation112; infants and

fetal exposure can occur from either of these methods.

What health effects have been linked to lead?

Lead is rapidly absorbed by the body, both by ingestion and inhalation. Toxic effects are dependent on dose,

exposure length and timing.

At low levels, lead exposure has been linked with spontaneous abortion, premature delivery and neurotoxic effects

in the developing fetus.112 The developing fetus may also be affected by anemia, motor or sensory system

disturbances, immune system disruption and reproductive system problems.113

In humans, lead in higher concentrations can cause anemia, impaired kidney function, abdominal pain and nervous

system disturbances. It is a known neurotoxin that can cause hallucinations, headaches, dullness, muscle tremors,

poor attention span and loss of memory.112,113

The International Agency for Research on Cancer (IARC) has declared that inorganic lead compounds are a

probable human carcinogen, while organic lead compounds are not yet classifiable as to their carcinogenicity.112

Result

Overall, mean concentrations of lead ranged from 0.3 µg/L to 0.6 µg/L (mean ± 95% confidence interval: 0.5 µg/L ±

0.1 µg/L). All pools were above the level of quantification.


The overall mean of the six Saskatchewan pools was larger than the three geographic means measured in Alberta.

As well, many of the Alberta pools were below the level of quantification (< 0.2 µg/L)d (Figure 16). There are no

other studies available using serum levels for comparison.

d For lead the level of quantification for Saskatchewan (0.1 µg/L) did differ from that in Alberta (0.2 µg/L)

51

0.7

Saskatchewan

0.7

Alberta

0.6 0.6

0.5 0.5

0.4 0.4

0.3 0.3

0.2 0.2

0.1 0.1

0.0


0.0

North Central South

Figure 16: Concentrations of lead in the blood serum of pregnant women in Saskatchewan (A) and Alberta by

geographic region (B). The blue lines represent the limit of quantification used in laboratory analysis. Estimates

provided represent a 95% confidence interval around the mean.

The recent First Nations Food, Nutrition and Environment Survey in Saskatchewan identified samples such as wild birds and game meat with higher concentrations of lead, likely as a result of contamination from lead-containing ammunition.65 They recommended the use of nonlead ammunition when hunting and if hunting with lead- containing ammunition, they recommended cutting away the portion of meat surrounding the entry are to decrease the risk of lead exposure.

Background

This section relates primarily to elemental and inorganic mercury. Methylmercury is addressed in the Organic

Chemicals section of this report.

Mercury is naturally occurring and is introduced into the environment by the weathering of rocks and minerals, as

well as volcanic activities. It is the only metal that exists in liquid form at room temperature. It exists naturally in

elemental, inorganic and organic forms.123 High levels have been detected in the Arctic due to global atmospheric

circulation.

Elemental and inorganic mercury compounds are used in a wide variety of industrial, commercial and medicinal

products, including electrical instruments, thermometers, lamps and lights, batteries, cosmetics, dental amalgams

and antiseptics,123 although it is being phased out of most products.124

How can you be exposed to mercury?

Mercury can be released into the air, water or soil by the use or disposal of mercury containing products, burning

of coal, and through mining and other industrial processes.

MERCURY (HG)

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What health effects have been linked to mercury?

Background concentrations of elemental and inorganic mercury are not known to cause any ill health effects in

humans.

In exceptional scenarios where exposures are high (such as in accidental releases or unusual occupational

exposures) elemental and inorganic mercury may cause serious health effects, such as neurological, renal and

digestive system dysfunction, rash and eye irritation.63

Result

Mean concentrations of mercury ranged from 0.2 µg/L to 0.7 µg/L (mean ± 95% confidence interval: 0.4 µg/L ± 0.1

µg/L). There is no clear geographic trend, but the highest concentration was detected in pool 6 (Far N).


The mean concentrations from the Alberta study (by age group) were values that fell within the lower range of the

Saskatchewan pools, with concentrations in the two NW pools in Saskatchewan approximating the pool average

concentration of those women 18 to 25 years. (Figure 17)


0.8 0.8

0.7 0.7

0.6 0.6

0.5 0.5

0.4 0.4

0.3 0.3

0.2 0.2

0.1 0.1

0.0


0.0

Age 18 - 25 Age 26-30 Age 31+

Figure 17: Concentrations of inorganic mercury in the blood serum of pregnant women in Saskatchewan (A) and

Alberta by age (B). The blue lines represent the limit of quantification used in laboratory analysis. Estimates

provided represent a 95% confidence interval around the mean.

Walker et al. completed a study in Arctic Canada (Northwest Territories and Nunavut) that included measuring

concentrations of inorganic mercury. Unfortunately, the results cannot be compared against the Saskatchewan or

Alberta values as the methodologies differed. This study does nonetheless point to elevated inorganic mercury

values in those who self-identify as Inuit compared to those who identify as either Dene, Métis or Caucasian. This

suggests that variations in country food consumption may explain variations in inorganic mercury levels126 and

may help to understand the variability seen between the geographic pools in Saskatchewan.

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Background

Strontium is a hard, white metal commonly found in nature that turns yellow when exposed to air. Rocks, soil,

dust, coal, oil, air, plants and animals all contain strontium. It exists in four stable isotopes and two radioactive

isotopes. Strontium compounds are used to make ceramics, glass products, pyrotechnics, paint pigments, other

products.127

Strontium-90 (one of the radioactive isotopes) was widely dispersed in the 1950s and 1960s in the United States as

fallout from nuclear weapons testing. Since that time, this isotope has been slowly decaying (half-life of 29.1

years).127 This study measured the non-radioactive form of strontium.

How can you be exposed to strontium?

Strontium naturally occurs in food and water however, additional strontium can be deposited into soil with the

disposal of coal ash, incinerator ash and industrial wastes. Depending on whether strontium in soil is soluble or

insoluble will determine whether it is likely to then migrate further into the ground and into groundwater.

Both stable and radioactive strontium background exposure occurs most often by breathing air, eating food or

drinking water that contains strontium. Food and drinking water are the most important sources, particularly

grains, leafy vegetables and dairy products.127

When strontium enters the body it either resides in the lungs (after inhaling strontium) or the bone, and the length

of time it remains in the body depends on the solubility of the compound. Excretion of strontium can happen

quickly through urine, feces or sweat or the metal may stay in the body for an extended period of time. Strontium

behaves similarly to calcium and can, in some cases, be built into bone matrix, depending on the age of the person

at the time of exposure.127

What health effects have been linked to strontium?

There is no negative human health effects linked to stable strontium.

Result

Overall, mean concentrations of strontium 88, a non-radioactive form of strontrium, ranged from 20.5 µg/L to 39.1

µg/L (mean ± 95% confidence interval: 26.9 µg/L ± 5.5 µg/L). There was no distinct geographic trend identified

across the pools.

Radioactive strontium was not evaluted in this study.


There is no value to compare in the Alberta study.

Two comparably small scale studies evaluated strontium levels in child-bearing age women can be used for

comparison. A Brazilian study of women aged 18 to 60 identified a mean plasma concentration of strontium to be

15.4 µg/L (standard deviation 4.2 µg/L).128 This value falls below the range of Saskatchewan pool concentrations

STRONTIUM (SR)

54

determined. While a Chinese study of non-pregnant, non-smoking women determined a median serum strontium

concentration of 57.59 (interquartile range 51.33-68.14) µg/L.129 The median value determined from China

exceeded both the Brazilian study and all Saskatchewan pools.

Background

Uranium is a naturally occurring element that is widespread in nature and found in rock, soil and water.

Distribution in the environment is based on existing geology and climatic processes.

Uranium is a weakly radioactive substance that exists as three isotopes in the environment: 238U, 235U and 234U. All

three naturally occurring isotopes are radioactive. It is usually found in an oxide form.130

Canada is the world’s second largest producer of uranium. Northern Saskatchewan, the source of Canadian

uranium, has some of the world’s most abundant and high grade deposits.131

Uranium is used as fuel for commercial nuclear power plants with industrial uses in ceramics, electron microscopy,

photography, as well as some military applications (e.g., armour plating, armour piercing ammunition).132

How can you be exposed to uranium?

The general population is most often exposed to uranium through diet, particularly root vegetables, and drinking

water especially from ground waters which naturally contain uranium in varying amounts.130 It is estimated that

an average person takes in between 0.07 to 1.1 μg of uranium through food each day.132

What health effects have been linked to uranium?

The health effects of background exposure to uranium are not known and the radiation risk from exposure to

natural uranium is very low. At high levels of exposure, uranium is known to cause kidney damange due to

chemical toxicity.130

Result

All pool concentrations were below the limit of quantification at 0.05 ug/L.


There is no value against which to compare in the Alberta study and no other source is available for comparison of

serum values. CHMS and the First Nations Biomonitoring Initiative demonstrated a high proportion of results for

whole blood and urine were below detection limits.

URANIUM (U)

55

The following substances are required by humans for normal physiological function. These are also known as trace

elements as they are only required in very small quantities. Given they are necessary to life, the following ten

substances can be linked to potential health effects in cases of either deficiency or excess.

Background

Boron occurs naturally in soil, water and food. It is required for normal development of plants and is “probably

essential”, as per the World Health Organization, in humans. Consumer products that contain boron or boron

compounds include laundry detergent, pesticides, facial creams and cleansers, plant foods and household

cleaners.133

How can you be exposed to boron?

Exposure to boron primarily occurs through consumption of food and water. The general public is not likely to be

exposed through air, although some occupational exposures are through inhalation.

What health effects have been linked to boron?

There have been studies in animals and humans that suggests that boron may play a role in reducing the risk of

osteoporosis but this has not been confirmed.134 Deficiency, though exceedingly rare and unknown in North

America, has been linked to adverse effects on embryonic development, brain function and cognitive performance.

Boron supplementation in people who are not deficient will not likely provide benefit.135

Very high exposures (over 30 g of boric acid) over a very short period of time can result in detrimental health

effects.

Result

The Saskatchewan pools had boron concentrations ranging from 13 µg/L to 24 µg/L (mean ± 95% confidence

interval: 17 ± 3.1 µg/L). There was no notable geographic variation.


Blood serum concentrations of boron in pregnant women in Alberta had mean concentrations ranging from 13.2

µg/L to 34.4 µg/L, with no trends between regions or across age groups. The Saskatchewan pools were quite

comparable to those in Alberta.

MINERAL MICRONUTRIENTS

BORON (B)

56

Background

Cobalt is found in rocks, water, soil, plants and animals. It is usually combined with other elements such as

oxygen, sulphur and arsenic. Cobalt is naturally released into the environment through leaching from soil,

airborne dust, sea spray, volcanic eruptions and forest fires. The burning of fossil fuels, sewage, sludge, phosphate

fertilizers, mining and smelting of cobalt-containing ores and industrial processes that use cobalt compounds are

all human-made sources of cobalt in the environment. Cobalt can exist in two important radioactive forms;

isotopes cobalt-60 and cobalt-57.136 This study measured the stable form of cobalt.

How can you be exposed to cobalt?

For most people, the vast majority of cobalt intake is from food including coffee and through vitamin B12 found in

meat and dairy products. In people who have a joint prosthesis made of cobalt alloys, exposure can be from the

prosthesis.

What health effects have been linked to cobalt?

Cobalt is a key component of vitamin B-12 (cobalamin) which is an essential nutrient for good health. Low levels of

vitamin B-12 can lead to anemia and neurological troubles. Exposure to cobalt levels normally found in the

environment is not harmful to humans.

Result

Overall, mean concentrations of cobalt ranged from 0.4 µg/L to 0.5 µg/L (mean ± 95% confidence interval: 0.5 µg/L

± 0.03 µg/L). All six pools had comparable concentrations and there was no distinct geographic pattern.


All Saskatchewan pools were higher than the overall mean serum concentration of the Alberta (mean ± 95%

confidence interval: 0.29 ± 0.05 µg/L ) (Figure 18).

COBALT (CO)

57

0.6

Saskatchewan AB

0.6

0.5 0.5

0.4 0.4

0.3 0.3

0.2 0.2

0.1 0.1

0.0


0.0

OA

Figure 18: Concentrations of cobalt in the blood serum of pregnant women in Saskatchewan (A) and Alberta (B).

Saskatchewan data is presented for each of the six pooled samples, and for an overall (OA) weighted arithmetic

mean of the six pools. An overall mean concentration (OA) is provided for Alberta. The blue lines represent the

limit of quantification used in laboratory analysis. Estimates provided represent a 95% confidence interval around

the mean.

Background

Copper has been mined and used by humans for over 5,000 years. Copper is used extensively for plumbing pipes,

particularly in domestic water systems. It is also used for electroplating, the production of alloys, as a fungicide, as

an antimicrobial agent and a variety of other industrial and commercial uses.137

Copper is an essential nutrient in mammals as it is required for normal enzyme function.

How can you be exposed to copper?

For the general population, copper is ingested in food. Less commonly exposure can result from inhalation of dust

particles containing copper or ingestion of drinking water.138

What health effects have been linked to copper?

Copper deficiency (less than 2 mg/day) can result in anemia, although exceedingly rare.

Copper, while generally considered to be non-toxic, can cause ill health effects in high doses (more than 15

mg/day).137 In these cases copper will build up in the liver and kidneys and cause harm to these organs.139

COPPER (CU)

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58

Result

The overall mean concentration of copper ranged from 1.81 x 103 µg/L to 2.13 x 103 µg/L (mean ± 95% confidence

interval: 1.96 x 103 ± 1.11 x 102 µg/L). There was little variation between the 6 pools.


The Saskatchewan pools approximated the Alberta mean concentrations which were grouped by age and

geographic region of Alberta.

Background

Iron is the fourth most common element that makes up the Earth’s crust. It has been used for many centuries in

the making of materials for tools and for construction. It is mined, smelted and is used in the manufacture of steel.

Iron is critical to human physiology, as many enzymes require it for normal functioning. Most iron in the body is

present in hemoglobin, the enzyme in red blood cells that carries oxygen to tissues. Women require more iron

than men, and pregnant women require increasing amounts of iron as the fetus develops through the pregnancy.

How can you be exposed to iron?

Iron is present in many foods and so the most common exposure route is through diet. Red meat, fish and poultry

contain the most easily absorbed iron. Intake through drinking water is also possible, but comparably much lower.

Health Canada recommends prenatal women take vitamin supplements including iron and folic acid. In workplace

settings, welders can be exposed to iron through welding fumes.

What health effects have been linked to iron?

Not enough iron in adults most often results in anemia, which causes fatigue and limited stamina.

Not enough iron in pregnant women can cause fatigue, heart stress, lower immunity and maternal anemia. It also

has consequences for the growing fetus including increased risk of premature delivery, low birth weight and

increased risk of perinatal infant mortality.140

Not enough iron in children can result in delayed motor or mental development.

Very high doses of iron can cause problems with the lining of the gastrointestinal tract, neurologic disturbances

and liver failure.141 This usually occurs through the accidental overdose of iron pills.

Result

Overall, mean concentrations for iron in the six pools of pregnant women sampled ranged from 967 µg/L to 1.23 x

103 µg/L (mean ± 95% confidence interval: 1.07 x 103 ± 82.4 µg/L). There was little inter-pool variation.

IRON (FE)

59


In the Saskatchewan study the mean concentration of iron (1.07 X 103 ± 82.4 ug/L) was slightly lower than the

mean concentration of iron measured in the Alberta study (1.2 X 103 ± 24 ug/L).

Background

Manganese is found in rocks and soils naturally, but it does not occur in nature as a pure metal but rather in

combination with oxygen sulphur or chlorine. It is often used in steel production, fireworks, dry cell batteries,

paints, for medical imaging and in cosmetics.142

How can you be exposed to manganese?

Most people are exposed to manganese through food, water, air and consumer products that contain manganese.

Grains, nuts, legumes and fruit have higher concentrations of the element compared to most other foods.142

Manganese is required for normal function of many enzymes in the human body. It is required for normal bone

formation, protection of cells and in the metabolism of amino acids, cholesterol and carbohydrates.142

What health effects have been linked to manganese?

Manganese deficiency is very rare, but when it does occur neurological effects may result.

High doses of ingested manganese can result in lung damage. High doses of inhaled manganese can result in a

condition known as manganism – tremors, difficultly walking and facial spasms.142

Result

Overall, mean concentrations of manganese ranged from 2.6 µg/L to 4.2 µg/L (mean ± 95% confidence interval: 3.5

µg/L ± 0.4 µg/L). All six pools had comparable levels of manganese.


The Alberta pooled mean is slightly lower than the Saskchewan pooled mean, but this difference is not statistically

significant.

Background

Magnesium is the eighth most common natural element. Magnesium alloys are used to make beverage cans,

pressure die-cast products, electrical equipment, portable tools, sports equipment, and many other products. It is

used in both the steel and chemical industries extensively. It is also found naturally in many foods.143

Magnesium is required for over 300 known enzyme reactions in the body.

MANGANESE (MN)

MAGNESIUM (MG)

60

How can you be exposed to magnesium?

Magnesium is found in many foods and food products. Green leafy vegetables, unpolished grains and nuts are all

rich in magnesium.144

What health effects have been linked to magnesium?

Magnesium deficiencies are exceptionally rare, but when they do occur they negatively affect heart, kidney,

muscle and nerve function. The most common effect of too much magnesium is its ability to act as a laxative,

although the human body can quickly adapt and resolve this issue in many cases. More seriously, high levels of

magnesium can result in changes in heartbeat, and at very high levels (plasma concentrations above 180,000 µg/L)

paralysis, respiratory depression, coma or even death may occur.143

Result

Overall, mean concentrations of magnesium ranged from 1.70 x 104 to 1.97 x 104 µg/L (1.86 x 104 µg/L ± 685 µg/L).

There was no notable variation between pools.


There is no value to compare in the Alberta study and no other similar studies available for comparison. Although

reference values may differ between laboratories, the magnesium reference value for Mayo Clinic Laboratories is

between 1.7 and 2.3 X 104 ug/L.167

Background

Molybdenum naturally occurs in the Earth’s crust and is found in combination with other elements. It is naturally

found in rocks, soil, sediment, surface water, groundwater, plants, animals and humans. Both natural and man-

made processes can release it into the environment, including weathering, combustion of coal, sewage sludge and

mining. Fertilizer use is an important source of aquatic species exposure.145

Molybdenum is required for three types of enzymes to work properly in the human body: sulphite

oxidase, aldehyde dehydrogenase, and xanthine oxidase.146

How can you be exposed to molybdenum?

Diet is the primary source of molybdenum.

What health effects have been linked to molybdenum?

Human health effects from low levels of molybdenum are unknown. In circumstances of long-term exposures to

very high levels (10-15 mg/day), gout-like symptoms can occur.146

MOLYBDENUM (MO)

61

Result

Overall, mean concentrations of molybdenum (Mo) ranged from 1.1 µg/L to 1.3 µg/L (1.2 µg/L ± 0.06 µg/L). There

is not a distinct pattern across pools.


Compared to the range of blood serum concentrations in pregnant women in Alberta (1.06 µg/L to 4.29 µg/L),

northern Saskatchewan presented with slightly lower overall concentrations (1.2 ± 0.060 µg/L).

Background

Nickel is hard, silvery-white metal that is commonly combined with other metals to form alloys. It is used to make

steel, nickel plate, battery production and as a catalyst. Alloys are used in coins and jewelry. Human activities such

as mining, industry, oil-burning, coal-burning and trash incineration can release nickel into the environment.147

How can you be exposed to nickel?

Exposure to nickel is primarily through food. Foods naturally high in nickel include chocolate, soybeans, nuts and

oatmeal. Wearing nickel containing jewelry or using consumer products contain nickel are less important

sources.147

What health effects have been linked to nickel?

The most common health effect of nickel exposure is an allergic reaction. Yet, this reaction is mostly in cases of

skin exposure and the result is most commonly a rash.147

Result

Overall, mean concentrations of nickel ranged from 0.4 µg/L to 2.08 µg/L (mean ± 95% confidence interval = 0.8

µg/L ± 0.6 µg/L).


The mean concentration of the Saskatchewan pools combined was statistically comparable to that found in the

Alberta study (0.9 ± 0.09 µg/L). The range of the Alberta results were from 0.386 to 5.58 ug/L.

Background

Selenium is a naturally occurring substance found distributed in the Earth’s crust, with some geographic areas

known to contain more selenium than others.148 Selenium and selenium compounds can be used in plastics,

rubber, agriculture, paints, ceramics and glass, electronic materials, drug products, natural health products,

lubricants and metallurgical applications.149 Mining and burning of fossil fuels also can release selenium into the

environment.

NICKEL (NI)

SELENIUM (SE)

62

Selenium can also be released into the environment through natural processes such as volcanic activity and

weathering of soils and rocks.149

Selenium is necessary for human functioning as antioxidant enzymes, enzymes that protect the body from tissue

damage, require it. It is also required for normal growth and metabolism.148

Fish consumption recommendations are in place for Beaverlodge and Martin Lakes in the Eastern Athabascan

Region of Saskatchewan since 2003 due to high concentrations of selenium in fish associated with historical

uranium mining in the area. These advisories provide recommendations of the maximum number of fish that it is

advisable to eat from these lakes (Personal communication: Dr. James Irvine).

How can you be exposed to selenium?

People are exposed to low levels of selenium on a daily basis through food, water and air, with most coming from

dietary sources. Food that are grown (e.g. grains) or fed (animal products) with feed grown in areas known to be

higher in selenium will contain more selenium.148 Selenium is an ingredient in some vitamin pills, including some

prenatal vitamins.

What health effects have been linked to selenium?

Selenium is a necessary substance for normal physiological functioning, but too high levels have been shown to

cause harm.

Not consuming enough selenium is hazardous to health as it makes the body more susceptible to illness caused by

other nutritional, biochemical or infectious stresses.148

Selenosis is a well described health outcome of consuming elevated levels of selenium (above 800 µg/day) over an

extended period of time. Selenosis is characterized by brittle hair and deformed nails and/or tooth decay. The

most extreme cases present with loss of feeling and control of the arms and legs.148

Result

Overall, concentrations of selenium ranged from 107.9 µg/L to 124.1 µg/L (118 µg/L ± 4.8 µg/L). There is no

apparent trend between pools.


The blood serum pools in Saskatchewan (means of 118 ± 4.77 µg/L) were slightly lower than the overall mean

serum concentration in Alberta of 154 ± 2.84 µg/L. (Figure 19)

63

160

140

120

100

80

60

Saskatchewan AB

160

140

120

100

80

60

40 40

20 20

0 0

SK NW SK NE SK Far N SK OA OA

Figure 19: Concentrations of selenium in the blood serum of pregnant women in Saskatchewan (A) and Alberta

(B). The blue lines represent the limit of quantification used in laboratory analysis. Estimates provided represent a

95% confidence interval around the mean.

Background

Zinc is an essential micronutrient for microorganisms, plants and animals. Nearly 100 known enzymes depend on

zinc as a catalyst.

How can you be exposed to zinc?

Food is the common source of zinc for humans. Water that has either been stored or passed through containers or

pipes that are coated with zinc to reduce rust could also contain zinc.150

What health effects have been linked to zinc?

Too little zinc can cause varying degrees of severity of a wide range of ill health effects, depending on the degree

of deficiency. Growth retardation, hair loss, diarrhea, delayed sexual maturation, impotence, eye and skin

problems and impaired appetite have all been associated with zinc deficiencies.151 Severe zinc deficiency is very

rare.

Maternal zinc deficiency may lead to poor birth outcomes and compromise infant growth and development. Too

little zinc during pregnancy may also result in pre-term birth.152

Consuming too much zinc in a short period of time (such as poisoning) can produce adverse health effects such as

stomach cramps, nausea and vomiting. Ingesting high levels of zinc for several months can cause anemia, damage

to the pancreas, and decreased levels of HDL (high density lipoprotein or “good”) cholesterol.150

ZINC (ZN)

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Result

Overall, concentrations of zinc ranged from 1303.86 µg/L to 1528.70 µg/L (mean ± 95% confidence interval:

1409.39 µg/L ± 66.40 µg/L). There were no meaningful differences between pools.


The mean concentration in Saskatchewan (1409.39 ± 66.40 µg/L) overlaps with the overall mean concentrations in

women in Northern, Central and Southern Alberta based on the Alberta study.

As technology advances and biomonitoring continues to evolve the ability to measure chemicals in a biological

matrix, such as blood serum, continues to improve. The ability to interpret the data in regards to risk to health

remains limited. Further research in a variety of fields is required before biomonitoring data can be used to

meaningfully and reliably determine risk. 153

The desire for knowledge was weighed against feasibility in this study, as is the case in many studies. Choices that

were made in regards to the study design resulted in several limitations.

In this study only the postal code of participants was collected and no other demographic information was

included. As a result, we cannot further evaluate these findings by particular sub-categories such as age of

mother, gestational age, etc.

The choice to use a pooled sample design over individual samples had the benefit of being more economical and

less likely to have a high number of concentrations below the limit of detection (this can complicate statistical

analysis). However, with pooled samples it becomes impossible to know individual level information about

participants.

Without knowing individual level data, it is impossible to answer queries such as whether all the participants have

approximately the same blood serum concentrations or if one person had a really high level and everyone else had

very low concentrations. Pooling makes it impossible to know the difference between the two.

STUDY LIMITATIONS

BIOMONITORING

STUDY DESIGN AND IMPLEMENTATION

MISSING DEMOGRAPHIC INFORMATION

POOLED SAMPLE DESIGN

65

Women whose prenatal blood screen was sent through Flin Flon Hospital laboratory were not included in the

study, and some of the prenatal blood specimens from LaRonge Health Center at the very beginning of specimen

collection were not included. It is estimated that pools 1, 2, 3, 4 and 6 included most of the pregnant women from

those regions, but pool 5 is likely less reflective. Therefore, all pools save pool 5 are likely able to represent what is

happening to most women in their respective geographies. Pool 5 does not represent women from those

communities where the blood work was sent through the Flin Flon Hospital (e.g. Creighton, Denare Beach, Pelican

Narrows and Deschambault).

This study analyzed all substances from the blood serum of participants. Although this simplifies the study and

made it economical, it limits some of the conclusions that can be derived from the information. For example,

some substances are better measured in another matrix (whole blood including blood cells, urine etc.).

Comparisons to other biomonitoring studies (such as CHMS or First Nations Biomonitoring Initiative) were often

not possible due to either differences in analytical methods or due to selection of another biological matrix. The

Saskatchewan study was designed to allow for comparison with the Alberta study. Even then comparisons

between the two studies were not always possible due to:

Inclusion of some substances in the Saskatchewan study that were not in the Alberta study.

Variations in how the pools were determined (e.g. geographically versus by age).

Variation in analytical techniques and resulting difference in the limit of detection

Without comparison it can be difficult to understand what a particular concentration may mean.

MISSING PEOPLE

LIMITED BIOLOGICAL MATRIX SELECTION

LIMITED OPTIONS FOR COMPARISON

66

Cross-jurisdictional projects are challenging for a variety of reasons. In the case of this study the legal, organization,

ethical and cultural milieus of each jurisdiction (Alberta and Saskatchewan) varied sufficiently that certain

modifications in study design were necessary. The efficient negotiation of these realities is a valuable lesson

learned from this study.

The structure of the team behind this biomonitoring initiative was a laudable example of cross-boundary

cooperation and collaboration.

Europe and the U.S. are leaders in large scale biomonitoring initiatives and have independently developed

approaches to improve cross-border biomonitoring initiatives. The CDC introduced (2009) the State Biomonitoring

Cooperative Agreement that supports the capability and capacity of states to conduct biomonitoring and state

population-based biomonitoring surveillance.154 In Europe the trans-national challenge was met by support from

European Union affiliated organizations acting as leads and from that a cohesive project was produced.155 The

Alberta-Saskatchewan biomonitoring initiative, was a collaborative and receptive process that demonstrates how

provincial governments can partner on large scale projects. Fundamentally, environmental contaminants do not

abide by boundaries and this must be considered when developing sound biomonitoring surveillance programs.

Without the mentoring, leadership and fiscal support from Alberta, biomonitoring in Saskatchewan would not

have occurred. At the time of the project there was little expertise and capacity around human biomonitoring

provincially and, as a result, no momentum for developing human biomonitoring as a surveillance tool in

Saskatchewan existed.

The area of biomonitoring is emerging as an important tool in environment and public health surveillance. Alberta

has opened the door with this study on Saskatchewan’s northern population, but there is an opportunity to go

further and develop human biomonitoring surveillance across the province.

The World Health Organization describes tobacco as “the most widely available harmful product on the market.”

Tobacco smoking is known to increase the risk of disability, disease and death, in particular due to cancer and

cardiovascular disease. Cigarettes contain over 4,000 chemicals, 50 of which are known carcinogens.156 In 2002,

37,209 Canadians died from tobacco use and tobacco use was attributed to 2,210,155 days in hospital.157

Tobacco smoke is known to cause elevated levels of heavy metals, including arsenic81, cadmium88 and lead115,

among various other chemicals.158 Measured lead levels in this study were higher than the Alberta study values

(Figure 16). There are many other chemicals also known to be statistically significantly different (often higher) in

smokers than in non-smokers including dioxins and furans, polyaromatic hydrocarbon and volatile organic

compounds (Table 5).

DISCUSSION

CROSS-JURISDICTION COLLABORATION

SMOKING - AN IMPORTANT SOURCE OF EXPOSURE AND RISK

67

Table 5: Chemicals found to be statistically significantly different for smokers and non-smokers in biomonitoring

studies in the United States. From the National Health and Nutritional Examination Survey (NHANES) 2011-2012

for males and females combined 20 years of age or over.

Chemical

Geometric Mean Concentrations (urine)

(95% Confidence Intervals)

Fold

Difference

Smokers

Non-Smokers

Metals and Arsenic Species

Cadmium (ug/g) 0.366 (0.295 – 0.383) 0.199 (0.163-0.216) 1.8

Lead (ug/g) 0.518 (0.465-0.576) 0.417 (0.386-0.451) 1.24

Molybdenum 35.6 (33.7 – 37.7) 40.4 (38.7 – 42.2) 0.88

Uranium 0.008 (0.007 - 0.009) 0.006 (0.005 – 0.007) 1.4

Thiocyanate

Thiocyanate (mg/g) 4.53 (4.02-5.10) 0.933 (0.881-0.988) 4.86

Metabolites of Polyaromatic hydrocarbons (PAHs)

2-Hydroxyfluorene (ng/g) 1260 (1140-1400) 190 (176-203) 6.63

3-Hydroxyfluorene (ng/g) 662 (595-738) 66.9 (62.0-72.1) 9.9

9-Hydroxyfluorene (ng/g) 666 (592-751) 240 (220-261) 2.8

1-Hydroxyphenanthrene 216 (200 – 234) 134 (123 – 145) 1.6

2-Hydroxyphenanthrene 123 (114 – 133) 62.4 (57.9 – 67.3) 2.0

3-Hydroxyphenanthrene 153 (144 – 163) 56.6 (52.3 – 61.3) 2.7

4-Hydroxyphenanthrene 41.6 (37.5 – 46.1) 20.4 (19.1 – 21.9) 2.0

1-Hydroxypyrene 266 (246 - 269) 96.8 (90.8 – 103) 2.7

1-Hydroxynapthalene 10.5 (9.06 – 12.1) 1.37 (1.25 – 1.51) 7.7

2-Hydroxynapthalene 13.5 (12.3 – 14.8) 3.69 (3.46 – 3.93) 3.7

Metabolites of Volatile Organic Compounds (VOCs)

N-Acetyl-S-(2-carbamoyl-2-

hydroxyethyl)-L-cysteine

31.1 (28.0 – 34.6)

15.0 (14.1 – 15.9)

2.1

N-Acetyl-S-(2-carbamoylethyl)-L-

cysteine

121 (110 – 134)

42.4 (39.9 – 44. 9)

2.9

N-Acetyl-S-(2-carboxyethyl)-L-cysteine 250 (224 – 278) 93.6 (87.6 – 100) 2.7

68

N-Acetyl-S-(3-hydroxypropyl)-L-

cysteine

1090 (968 – 1230)

224 (208 – 241)

4.9

N-Acetyl-S-(2-cyanoethyl)-L-cysteine 134 (118 – 151) 1.75 (1.57 – 1.94) 76.6

N-Acetyl-S-(N-methylcarbamoyl)-L-

cysteine

455 (390 – 531)

126 (119 – 134)

3.6

N-Acetyl-S-(3,4-dihydroxybutyl)-L-

cysteine

365 (340 – 392)

269 (257 – 281)

1.4

N-Acetyl-S-(4-hydroxy-2-butenyl)-L-

cysteine

63.1 (55.1 – 72.2)

8.12 (7.41 – 8.89)

7.8

N-Acetyl-S-(2-hydroxypropyl)-L-

cysteine

115 (99.4 – 134)

61.0 (54.8 – 67.9)

1.9

N-Acetyl-S-(3-hydroxypropyl-1-

methyl)-L-cysteine

1969 (1720 – 2240)

388 (362 – 416)

5.1

t,t-Muconic acid 132 (117 – 150) 73.8 (67.1 – 81.1) 1.8

Mandelic acid 311 (280 – 345) 150 (141 – 160) 2.1

2-Methylhippuric acid 109 (96.5 – 123) 30.1 (27.0 – 33.6) 3.6

3-and 4-Methylhippuric acid 732 (647 -828) 201 (187 – 215) 3.6

Phenylglyoxylic acid 338 (306 – 374) 186 (172 – 200) 1.8

*where applicable, creatine corrected levels provided, +highlighted chemicals were assessed in this study

Cotinine, a substance measured in this study, is a primary nicotine metabolite and is a recognized marker of

smoking. Non-smokers typically have serum cotinine levels below 5 ng/mL.12,13 The mean cotinine level of the 6

pools was 58.03 ng/mL (95% CI 52.40-63.66 ng/mL), suggesting that a sizeable number of participants either

smoked themselves or were exposed to second-hand smoke at the time of their blood sample collection.

69

Figure 20: Tobacco impact on biomonitoring

In 2013, 17.6% of people smoked in Saskatchewan, while the national rate was only 14.6%.158 In 2010, those living

in northern Saskatchewan were smoking at nearly twice the provincial rate. Almost half of the population of

northern Saskatchewan lives in First Nations communities and it is estimated that 59% of on-reserve persons

smoke tobacco.

A questionnaire administered to women postpartum in Saskatchewan (2007-2011) revealed that about 54.2% of

the northern population did smoke during pregnancy, compared to 24.2% of the general Saskatchewan

population.160 The Athabasca Health Authority, Keewatin Yatthé and Mamawetan Churchill River Health Regions

reported 73%, 54.5% and 49% of women who smoked while pregnant, respectively. 91

This is to say that the cotinine levels detected align with epidemiologic evidence – that smoking in northern

Saskatchewan remains a priority public health concern.

The Saskatchewan Ministry of Health is responsible for developing and amending The Tobacco Control Act and The

Tobacco Control Regulations. The goal of this legislation is to reduce youth access to tobacco products and protect

Saskatchewan residents from the harms associated with environmental tobacco smoke. The Act was put into

place in 2002 and has since been amended. Laws within The Tobacco Control Act include a ban on smoking in

70

enclosed public places, in cars with children under the age of 16 present, around doorways, windows and air

intakes of public buildings, a ban on tobacco use on school grounds, and a number of restrictions on the sale and

advertising of tobacco products. As of October 1, 2010, amendments to The Tobacco Control Act further reduce

youth access to tobacco products and continue to protect Saskatchewan people from the harms of environmental

tobacco smoke. On April 1, 2011, the provision of The Tobacco Control Act banning the sale of tobacco and

tobacco-related products in pharmacies came into effect. The Federal government has instituted Tobacco

Reporting Regulations which ensures that tobacco manufacturers provide annual reports to Health Canada with

their product ingredients, sale numbers, promotional activities and toxic constituents.161

The cotinine levels from this study, beyond putting some of the other chemical findings in context, can be used as

a benchmark to follow future trends in tobacco use and the effectiveness of current and future tobacco control

strategies in the region.

The findings in this study are of a specific set of chemicals in the blood serum of a select number of people over a

given time. The amount of chemical present at the time of blood draw depends on a wide variety of factors

including time of exposure, length of exposure, the chemical properties of the substance itself and the physiology

of the participant. Nonetheless, the detected amount of chemical provides valuable baseline information on which

to build.

The interpretation of results in a biomonitoring study can be challenging - environmental research is complex,

and consequentially scientific controversies and uncertainties are expected.8 As well, the assessment of human

health risks associated with chemicals is complex since some chemicals may not cause any health concerns at low

levels and that levels of concern (threshold levels) are not known for all chemicals. An individual or a community

may feel anxiety due to being made aware of the presence of a given substance in a biomonitoring study, but may

be left with uncertainty as to what to do with that information.

Given the improvements in laboratory testing, many substances can be detected at minute quantities, so, as in the

case of this study, a region can be told that they are being exposed to chemicals or exposed at a higher level

compared to another region without an understanding of their health risk. To address these concerns where

possible, further explanation will be provided to put the value in context. For some levels, individual action may

reduce exposures, whereas other exposures may require broader societal changes. For many levels, there may not

be any known health effect; but the value will be important for future assessments to determine if exposures are

increasing.

The findings of this study focus on human exposure to various chemicals, but the presence or absence of chemicals

in the participants reflects to some degree the physical and social environments in which they exist. The social

SPECIAL CONSIDERATION IN INTERPRETATION

BIOLOGICAL

PSYCHOLOGICAL

SOCIAL

71

determinants of health such as physical and social environments, are well known to influence the health of

populations.162

Communities in northern Saskatchewan have specific physical and social environment concerns.91 Housing

conditions, access to fresh and clean water and indoor air quality are other important elements of the physical

environment that affect health and can be sources of exposure to a variety of substances.163 In particular, smoking

rates are higher in this area compared to the rest of the province (smoking is a major contributor to indoor air

quality), and these elevated rates of smoking influence some of the findings in this study.

Those living in northern Saskatchewan tend to draw on traditional food sources (such as hunting and fishing) to

meet their foods needs. Thus, exploring country foods as a source of exposure for some substances has value.

Studies that have explored the relationship between traditional diets and chemical expsoures such as

methylmercury in northern Canada, including northern Saskatchewan, have identified that a good understanding

of possible exposure balanced against the environmental, societal and individual values of consuming country

foods is important.164,165

Various substances that have been discussed in this study, particularly a subset of the organic chemicals, are

known to, or considered to possibly be, passed on through breast milk when a mother is breastfeeding.

It is well understood that the benefits of breastfeeding outweigh the risks of potential introduction of some of

these substances to a newborn or infant. Breastfeeding is the best food to help a newborn grow and develop

healthfully. It has been linked to improved cognitive skills. It is often also the most practical and affordable

option.

As with all risk considerations, both the risk of exposure and the risk of the actions taken to avoid the exposure

should be thoroughly weighed. Although in some cases that can be complex, in the case of breastfeeding the

benefits of continuing to breastfeed far outweigh the possible risk of exposure to some chemicals. Breastfeeding is

better.

A human health risk assessment (HHRA) is a process wherein the risk to human health and wellbeing is estimated

based on exposure. Often the exposure is chemical. A HHRA attempts to answer questions around what health

effects could result from exposure to a particular chemical or set of chemicals over a period of time.

A biomonitoring study does not provide sufficient evidence to complete a risk assessment. The information found

by biomonitoring can be used to inform a complete human health risk assessment. Biomonitoring does not

provide information about how or to what degree a specific exposure occurred. For most substances

biomonitoring just gives a snap shot in time and does not allow for a complete understanding of how much a

person is exposed to a certain substance over time. Detailed dose and exposure assessments are necessary

elements of a HHRA.

The findings of this study can provide insight into whether a thorough HHRA is a reasonable next step, but can also

be a resource for any future HHRAs in the region.

BALANCING RISK – BREAST FEEDING IS BETTER

RISK ASSESSMENTS – THE ROLE OF BIOMONITORING

72

The study provides information on serum levels of a wide range of environmental chemical levels in pregnant

women from various geographic areas in northern Saskatchewan. This information is useful as baseline

information for monitoring in the future as well as for public policy and preventive health approaches. For

some of the environmental chemicals, one is able to make direct comparisons with levels in pregnant women

in other areas such as in Alberta.

Overall, most of the environmental chemical testing for northern Saskatchewan revealed levels lower than or

comparable to levels in pregnant women in Alberta. Some highlights include:

• Some specific chemicals in the categories such as polybrominated diphenyl ethers (flame retardants),

perfluorochemicals, most pesticides tested, dioxins and furans, were either lower than Alberta levels or

were undetectable. Uranium, nonylphenol and bisphenol A were also not detectable or were below the

level that could be accurately measured.

• Selenium and molybdenum were slightly lower than the average levels in Alberta. Iron levels were also

slightly lower in Saskatchewan than Alberta women but cobalt was higher. Both iron and cobalt help

prevent anemia (weak blood from low iron or vitamin B12).

• The levels of lead, a heavy metal, were higher than the average levels seen in Alberta. People may be

exposed to lead through lead-based paints (in older homes), drinking water coming in contact with old

lead plumbing, consumer products, or the ingestion of lead shot or lead bullet fragments in country foods.

Smokers or those exposed to second hand smoke tend to have higher levels.

• Mercury levels were comparable to those in Alberta; however, the levels in the far northern area of

Saskatchewan were higher. Methylmercury levels tend to be higher in those who consume a lot of fish

especially large predatory fish.

• Continine levels, a breakdown product of nicotine, were higher in northern Saskatchewan women

indicating higher exposures to tobacco smoke either through smoking or passive smoke exposure.

Exposure to tobacco smoke increases exposure to many other environmental chemicals as well.

A factsheet has been prepared called “Reducing My Exposure to Environmental Chemicals” which is available at:

https://publications.saskatchewan.ca:443/api/v1/products/101376/formats/112050/download

CONCLUSIONS


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Alberta Health provided funding for analytical testing through the operating grant to the Alberta Centre for Toxicology at the University of Calgary.

The Alberta Centre for Toxicology provided analytical services, technical advice and administrative support.

Members of the technical working group provided in-kind technical contributions through study design and planning, and the review and discussion of results and report materials.

The technical report and this summary report were prepared by: Dr. James Irvine Saskatchewan Ministry of Health & SK Health Authority Megan Reichert Alberta Health Briana Yee Saskatchewan Ministry of Health (summer student) Dr. Jasmine Hasselbach Public Health & Preventive Medicine Resident, SK Ministry of Health

With contributions from:

Technical Working Group: Tim Macaulay Saskatchewan Ministry of Health Dr. Jennifer Graydon Alberta Health Dr. Valerie Mann Saskatchewan Ministry of Health

Nicole Maserek Saskatchewan Ministry of Health Fred Ackah Alberta Health Dr. Weiping Zhang Alberta Health Dr. David Kinniburgh Alberta Centre for Toxicology

Dr. Amy MacDonald Alberta Centre for Toxicology Maureen Anderson Public Health Agency of Canada Placement – SK Ministry of Health Haoer Ying Saskatchewan Ministry of Health (summer student) Sheila Kelly Saskatchewan Ministry of Health

Other contributors: Penni Edwards Alberta Centre for Toxicology

Patricia Parmentier Alberta Centre for Toxicology Xu Zhang Alberta Centre for Toxicology Dr. Stephan Gabos Environmental Health Consultant, University of Alberta Dr. Don Schopflocher Consultant Sylvia Tiu Contractor, Alberta Centre for Toxicology Dr. Greg Horsman Roy Romanow Provincial Laboratory Dr. Paul Levitt Roy Romanow Provincial Laboratory Jim Putz Roy Romanow Provincial Laboratory

Special thanks for valuable editorial comments: Rolf Puchtinger Saskatchewan Ministry of Health

Also special thanks to those providing support: Dr. Kevin McCullum Saskatchewan Ministry of Environment Dr. Ibrahim Khan & Tim Bonish First Nations Inuit Health Branch, Indigenous Services Canada Brenda Ziegler & Dr. Nnamdi Ndubuka Northern Intertribal Health Authority Cindy Rogers Saskatchewan Ministry of Health

ACKNOWLEDGEMENTS

northern saskatchewan prenatal biomonitoring study ...€¦ · the biomonitoring study was intended...

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